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The role of bone-targeted therapies for prostate cancer in 2017
1Division of Urology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.
Purpose Of Review:
Bone-targeted agents (BTAs), such as zoledronic acid and denosumab, delay the occurrence of skeletal-related events (SREs) in metastatic prostate cancer (PCa) patients. Recently, several agents, such as abiraterone acetate, enzalutamide and radium-223, were approved for the treatment of metastatic castration-resistant PCa (mCRPC). These agents resulted in improved overall survival (OS), pain control and had positive effects on bone health. Combining BTAs to the newly approved agents demonstrates additional benefits that warrant a review of available evidence looking at appropriate combination therapies and timing of BTAs for optimizing the management of advanced and metastatic PCa.
Recent Findings:
Post-hoc analyses of randomized trials demonstrated some benefits from combination therapy, such as increased OS when denosumab was used concurrently with radium-223 and when BTAs were used with abiraterone acetate. BTAs were not beneficial for the prevention of bone metastases.
Summary:
There is a suggestion of synergy or additive effects between BTAs and new agents approved for the treatment of metastatic PCa, resulting in potential clinical benefits. Therefore, prospective randomized studies evaluating the safety and benefits of combination therapies to address gaps in the literature are needed to optimize treatment of mCRPC.
Insights
Bone-targeted agents (BTAs) combined with new prostate cancer treatments may improve survival. Further research is needed to confirm benefits and optimal timing for advanced prostate cancer management.
Area of Science:
- Oncology
- Pharmacology
Background:
- Bone-targeted agents (BTAs) like zoledronic acid and denosumab are used for skeletal-related events (SREs) in metastatic prostate cancer (PCa).
- New agents such as abiraterone acetate, enzalutamide, and radium-223 have improved outcomes in metastatic castration-resistant PCa (mCRPC).
Purpose of the Study:
- To review evidence on combining BTAs with newly approved agents for advanced and metastatic PCa.
- To explore optimal combination therapies and timing of BTAs for improved patient management.
Main Methods:
- Review of post-hoc analyses from randomized trials.
- Evaluation of combination therapies involving BTAs and new mCRPC agents.
Main Results:
- Combination therapy showed potential benefits, including increased overall survival (OS) when denosumab was used with radium-223, and BTAs with abiraterone acetate.
- BTAs were not found to be beneficial for preventing bone metastases.
Conclusions:
- Synergistic or additive effects between BTAs and new agents suggest potential clinical benefits in mCRPC.
- Prospective randomized studies are required to evaluate the safety and efficacy of combination therapies and optimize treatment strategies.
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