News | August 12, 2009

Higher Rates of Osteoporosis in Prostate Cancer Patients Using ADT

August 12, 2009 - There are higher rates of both osteoporosis and nonpathologic fractures for men with nonmetastatic prostate cancer using androgen-deprivation therapy (ADT).

The role of ADT in men with metastatic prostate cancer – especially patients who receive external beam radiotherapy or who have node-positive disease - has been prospectively established. However, the most common use of ADT in the U.S. is for nonmetastatic prostate-specific antigen failure, for which prospective evidence of benefit is lacking.

Bisphosphonates have been widely used to lower incidence of skeletal events (e.g., pathologic fractures in patients with metastatic disease) and to attenuate development of osteoporosis. However, use of this class of drugs carries a small but real risk for development of renal insufficiency and osteonecrosis. A novel compound that might be used in this setting is denosumab, a human monoclonal antibody that binds to the receptor activator of nuclear factor-B ligand (a key mediator of osteoclast function and survival).

To characterize the effects of denosumab on bone-mineral density (BMD) and fracture risk, an international group of investigators conducted an industry-supported, phase III double-blind study involving 1468 prostate cancer patients who received ADT for 12 months. Patients were older than 70 or, if younger, had osteoporosis or histories of osteoporotic fractures. Prior use of bisphosphonates was permitted if 3 years had elapsed since last oral administration or 5 years had elapsed since last intravenous administration. Patients were randomized to receive denosumab (60 mg subcutaneously) or placebo every 6 months; 63% of patients completed the 36-month study.

At 24 months, patients who received denosumab achieved greater improvements in lumbar spine BMD (the primary endpoint) than did those in the placebo group (5.6% vs. –1.0%; P

The current findings clearly demonstrate the efficacy and safety of denosumab to improve BMD and lower fracture rates in men who are treated for nonmetastatic disease. Researchers need to determine whether decreasing the use of ADT for nonmetastatic disease might negate the need for many patients with prostate cancer to receive osteoporosis therapy in the first place.

Source: Published in Journal Watch Oncology and Hematology August 11, 2009

Citation(s):
Smith MR et al. Denosumab in men receiving androgen-deprivation therapy for prostate cancer. N Engl J Med 2009 Aug 20; 361:745. (http://dx.doi.org/10.1056/NEJMe0809003)

Khosla S. Increasing options for the treatment of osteoporosis. N Engl J Med 2009 Aug 20; 361:818. (http://dx.doi.org/10.1056/NEJMe0905480)

For more information: oncology-hematology.jwatch.org

Related Content

RaySearch Developing RayCommand Treatment Control System for U.K. Proton Therapy Facility
Technology | Radiation Therapy | December 10, 2018
RaySearch has decided to develop a treatment control system, RayCommand, to act as a link between its RayStation...
Mirada Medical Joins U.K. Consortium Exploring Healthcare AI
News | Artificial Intelligence | December 04, 2018
Mirada Medical, a leading global brand in medical imaging software, will form part of an artificial intelligence (AI)...
Sponsored Content | Videos | Radiation Oncology | November 30, 2018
Accuray's philosophy is to personalize treatments to exactly fit the patient.
Ohio State University to Open Region’s First Proton Therapy Facility

Image courtesy of The Ohio State University James Comprehensive Cancer Center

News | Proton Therapy | November 21, 2018
The Ohio State University Wexner Medical Center and the Arthur G. James Cancer Hospital and Richard J. Solove Research...
Immune Inflammatory Levels Linked to Disease-Free Survival in Prostate Cancer
News | Prostate Cancer | November 19, 2018
Data from a validation study of a high-risk prostate cancer trial suggests that higher levels of pretreatment...
Merit Medical Completes Acquisition of Cianna Medical
News | Women's Health | November 14, 2018
Disposable device manufacturer Merit Medical Systems Inc. announced the closing of a definitive merger agreement to...
Videos | ASTRO | November 08, 2018
ITN Editor Dave Fornell took a tour of some of the most innovative technologies on display on the expo floor at the 
The Fujifilm FCT Embrace CT System displayed for the first time at ASTRO 2018.
360 Photos | 360 View Photos | November 07, 2018
Fujifilm's first FDA-cleared compu...