Bone Resorption Inhibitors: Are They of Benefit to Patients Being Treated for Metastatic Prostate Cancer?
Posted: Tuesday, September 14, 2021
According to Daniel Y.C. Heng, MD, MPH, of Tom Baker Cancer Centre, Calgary, Alberta, Canada, and colleagues, patients with metastatic castration-resistant prostate cancer harboring bone metastases may benefit from the combination of bone resorption inhibitors with abiraterone acetate and prednisone as a first-line therapy. The investigators discovered that patients who received bone resorption inhibitors such as zoledronic acid or denosumab along with first-line combination therapy experienced longer overall survival than those who did not receive these bone-strengthening agents—particular in those with high-volume disease. The results of this retrospective study were published in JAMA Network Open.
The investigators focused on 745 patients with metastatic castration-resistant prostate cancer and bone metastases who received either abiraterone acetate and prednisone alone (n = 529) or with added bone resorption inhibitors (n = 216) as first-line therapy. The median patient age was 77.6 years, and a majority of participants were White (93.8%). High-volume and low-volume disease affected 420 and 276 men, respectively.
With a median follow-up of 23.5 months, patients who received bone resorption inhibitors demonstrated a significantly longer overall survival when compared with those who did not receive them (31.8 vs. 23.0 months; P < .001). Furthermore, patients with high-volume disease given bone resorption inhibitors also had a greater overall survival benefit than patients with low-volume disease (33.6 vs. 19.7 months; P < .001).
The risk of death was decreased by 35% in the cohort given bone resorption inhibitors, although these patients were observed to develop skeletal-related-events in a shorter time than did patients given abiraterone acetate and prednisone alone (33.6 vs. 19.7 months); this risk was more than double that in patients with low-volume disease (hazard ratio [HR] = 2.29). Most notably, concomitant bone resorption inhibitors were found to be independently associated with longer overall survival (HR = 0.64, P < .001).
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.