Background and Importance According to latest practice guideline, concurrent administration of poly (ADP-ribose) polymerase inhibitors (PARPi) and androgen deprivation therapy (ADT) may have synergistic efficacy for metastatic castration-resistant prostate cancer (mCRPC) patients. However, the effectiveness of PARPi and ADT was highly depended on mCRPC patients’ heterogeneous gene status. To move toward precision medicine in mCRPC treatment, high level of evidence summarising newest clinical trials was unmet need.

Aim and Objectives To conduct a systematic review and meta-analysis to estimate effectiveness of PARP inhibitors combined with ADT versus standard ADT in the mCRPC patients with homologous recombination repair (HRR) positive and negative.

Material and Methods We searched PubMed, Embase and Cochrane databases from 2009 to September 2023 for all randomised clinical trials. No language or other restrictions were imposed on the searches. Two review authors independently screened the titles and abstracts of each trial before obtaining the full text for all potentially eligible trials and assessed the included trials for risk of bias. The outcomes included progression free survival and overall survival among all patients, HRR+ and HRR-. A fixed-effects meta-analysis was applied to pool hazard ratio (HR) with 95% confidence intervals (CIs).

Results A total of five studies with a total of 1207 PARPi and 1206 placebo patients were included. Compared to standard ADT, the PARPi plus ADT was associated with a 38% PFS improvement (HR: 0.62; 95% CI: 0.54–0.72) and OS prolong (HR: 0.85, 0.73–0.99) in the overall patients. Among HRR+ patients, the pooled PFS and OS were 0.65 (0.52–0.81) and 0.66 (0.45–0.95), respectively. Among HRR- patients, the pooled PFS and OS were 0.74 (0.59–0.92) and 0.89 (0.70–1.14), respectively.

Conclusion and relevance Based on current evidence, we suggest that the combination of PARPi and ADT in patients with mCRPC to significantly improved both progression-free survival and overall survival rates, especially for HRR+ patients. As hospital pharmacists, we play an auxiliary role in shared decision-making system. We can use skill of evidence-based medicine to integrate and explain evidence and provide patients with more precisely and effectively therapeutic strategies.

Conflict of Interest No conflict of interest.