From: the 2014 ASCO GU Meeting
Abstract No: 35
Researchers have found in a randomized controlled trial of men with metastatic castration-resistant prostate cancer (mCRPC) the use of the treatment denosumab was superior to the more commonly used zoledronic acid (ZA) for reducing skeletal-related events (SRE). SREs are defined as a pathological fracture, surgery or radiation to the bone [including the use of radioisotopes], or spinal cord compression.
In the trial men with mCRPC who had at least one or more SRE and never received IV bisphosphonate were randomized to receive either denosumab 120 mg or IV ZA 4 mg (adjusted for creatinine clearance) every 4 weeks. Oral calcium and vitamin D supplements were also recommended.
This trial confirmed the previously reported result from other studies that fewer men who received denosumab than ZA had confirmed first SREs as well as additional multiple SREs.
The median (95% CI) estimate of time to first SSE for denosumab was not reached (28.8 mo, not estimable), and for ZA it was 24.2 (20.7, 30.2) mo (HR = 0.78 (0.66, 0.93) P = 0.01).
Denosumab reduced the risk of skeletal events in men with mCRPC regardless of endpoint definition as SRE or SSE. The risk of developing SSEs was reduced by up to 22% when comparing denosumab with ZA.
Take Home: Denosumab is superior to Zolendronic Acid. Despite this many physicans still use Zolendronic acid, probably because they are more familiar with it. Question your doctor if they recommend ZA and obtain a good explanation why not Denosumab.
J Clin Oncol 32, 2014 (suppl 4; abstr 35)
Author(s): Matthew R. Smith, Robert E. Coleman, Laurence Klotz, Kenneth B. Pittman, Piotr Milecki, Rachel Wei, Arun Balakumaran, Karim Fizazi; Harvard Medical School and Massachusetts General Hospital, Boston, MA; Weston Park Hospital, Sheffield, United Kingdom; University of Toronto, Toronto, ON, Canada; The Queen Elizabeth Hospital, Adelaide, Australia; Wielkopolskie Centrum Onkologii, Poznan, Poland; Amgen, Inc., Thousand Oaks, CA; Institut Gustave Roussy, University of Paris Sud, Villejuif, France
Clinical trial information: NCT00321620.
Joel T. Nowak, M.A., M.S.W.
I’ve been on Xgeva injections since the beginning of my ADT in November, 2012. Thus far, my bone mets have been stabilized, not having increased in number or size.
I’m also on Lupron (switching to Firmagon tomorrow) bicalutamide and Avodart. Calcium citrate supplements and D daily.
Pelvic lymph glands and prostate have also shrunk somewhat.
But my PSA has been slowly climbing and testosterone levels have been jumping up and down, hence my decision to return to Firmagon, even though the injections are painful.
I attribute my success in limiting the bone mets mainly to the Xgeva, and I recommend it highly.