Panel Backs Bone Drugs for Postmenopausal Breast Cancer


“Appropriately selected postmenopausal women with breast cancer warrant consideration for adjuvant bisphosphonate therapy, according to an updated clinical guideline.

“Either zoledronic acid (Zometa) or clodronate may be considered for adjuvant therapy, as data supporting use of other bisphosphonates remain limited. The RANK ligand-targeted monoclonal antibody denosumab (Xgeva) did not make the cut as recommended therapy because of a lack of long-term survival data to support its use.

” ‘Data for adjuvant denosumab look promising but are currently insufficient to make any recommendation,’ concluded a panel of experts representing the American Society of Clinical Oncology (ASCO) and Cancer Care Ontario.”

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Early Chemotherapy Improves Survival for Men with Prostate Cancer

“Two papers from UCL show that having early chemotherapy improves survival for men with prostate cancer. The papers, published in the Lancet and Lancet Oncology, report the results from the STAMPEDE clinical trial and a meta-analysis.

“Both papers looked at the use of a chemotherapy drug called docetaxel. Docetaxel is already used for men with prostate cancer once hormone therapy has stopped working. In STAMPEDE and the meta-analysis, the researchers looked at using it earlier, when men are starting long-term hormone therapy. Both studies found that adding docetaxel improved survival for these men.

“The studies also looked at whether the drug zoledronic acid improves survival. Zoledronic acid is used to reduce the risk of bone problems in men whose cancer has spread to their bones, and whose hormone therapy has stopped working. The new studies looked at using it earlier, when men are starting long-term hormone therapy. Both studies found that adding zoledronic acid did not improve survival for these men.”

De-escalation of Bone-Targeting Agents Appears Safe in Bone Metastases

“A new meta-analysis suggests that de-escalation of bone-targeted agents such as bisphosphonates and denosumab is a safe strategy in patients with bone metastases from breast cancer. There is a growing body of evidence suggesting such de-escalation will soon be considered standard of care.

“Bone-targeted agents are generally given every 3 to 4 weeks beginning at the time of diagnosis of bone metastases, until death. ‘If de-escalation of treatment is as efficacious as 3–4 weekly dosing, it could reduce clinic visits, drug side effects for patients, in addition to reducing costs to both the patient and the health care system,’ wrote study authors led by Mark Clemons, MD, of the Ottawa Hospital Cancer Centre in Canada.

“Clemons and colleagues conducted a systematic review and meta-analysis of published research on de-escalation of bone-targeted agents; six studies reported data for at least one ‘outcome of interest’ involving pamidronate, zoledronate, and denosumab. Results of the analysis were published online ahead of print in Annals of Oncology.

Bone Drugs Equal as Breast Cancer Therapies

“One bone-preserving drug is as good as another in early stage breast cancer, a researcher said here.

“In a large randomized trial, there were few differences in anti-cancer efficacy among three different members of the bisphosphonate class, according to Julie Gralow, MD, of the University of Washington in Seattle.

“And the overall safety of the drugs was also similar, Gralow reported at the annual meeting of the American Society of Clinical Oncology.

“But the study might not help settle a continuing controversy in oncology over the use of the drugs, which normally are prescribed to slow bone embrittlement by inhibiting the action of osteoclasts.”

Docetaxel Improves Survival for Men with Hormone-Naive Prostate Cancer

“The addition of docetaxel to standard therapy clinically and significantly improved survival for men with locally advanced or metastatic hormone-naive prostate cancer, according to findings from the STAMPEDE trial.

“However, the addition of zoledronic acid to standard therapy was not associated with improved survival, results showed.

“ ‘We hope our findings will encourage doctors to offer docetaxel to men newly diagnosed with metastatic prostate cancer, if they are healthy enough for chemotherapy,’ Nicholas David James, MD, PhD, director of the cancer research unit at the University of Warwick and consultant in clinical oncology at Queen Elizabeth Hospital in the United Kingdom, said in a press release. ‘Men with locally advanced, nonmetastatic prostate cancer may also consider docetaxel as part of upfront therapy, as it clearly delays relapse.

“ ‘It’s also clear that zoledronic acid does not benefit these patients and should not be offered as an upfront treatment for advanced prostate cancer,’ James said.”

Drugs Home in on Bone Metastases in Prostate Cancer

Bone metastases are common in patients with metastatic castration-resistant prostate cancer (CRPC). They are associated with increased risk of death due to a number of complications such as bone fractures, compression of the spinal cord, and pain. Radiation of the affected bone sites is used as a palliative measure to relieve pain. The U.S. Food and Drug Administration (FDA) has also approved certain drugs for treatment of bone metastases in CRPC including the following: Continue reading…

No Disease-Free Survival Benefit of Adjuvant Zoledronic Acid in High-Risk Patients With Early Breast Cancer

The gist: Some people with breast cancer are treated with adjuvant therapy after surgery to keep their cancer from returning. A recent study with volunteer patients tested the effectiveness of adjuvant therapy with zoledronic acid. It was found that the treatment did not, in fact, increase the amount of time that high-risk, early-stage breast cancer patients lived without their cancer returning. However, it did reduce the risk of bone metastases.

“In the open-label phase III AZURE trial reported in The Lancet Oncology, Coleman et al found that adjuvant zoledronic acid treatment in patients with high-risk early-stage breast cancer provided no overall disease-free survival benefit. A reduction in bone metastases was observed, and women who were > 5 years postmenopause appeared to derive a disease-free survival benefit…

“In the trial, 3,360 women with stage II or III breast cancer from 174 centers in seven countries were randomly assigned between September 2003 and February 2006 to receive standard systemic adjuvant therapy with or without intravenous zoledronic acid. Zoledronic acid was given at 4 mg every 3 to 4 weeks for six doses, every 3 months for eight doses, and every 6 months for five doses, for a total of 5 years of treatment. The primary endpoint was disease-free survival in the intent-to-treat population…

“Median follow-up was 84 months. Compared with the control group, the zoledronic acid group had similar disease-free survival (adjusted hazard ratio [HR] = 0.94, P =  .30), invasive disease-free survival (HR = 0.93, P = .22), overall survival (HR = 0.93, P =  .37), and risk of distant recurrence (HR = 0.93, P = .29). Patients in the zoledronic acid group had reduced risk of bone metastases as a first event (HR = 0.78, P = .020) and at any time during follow-up (HR = .81, P = .022).”

Thematic Session 10: Update on treatment options for patients with CRPC

“There are new treatment options for castration resistant prostate cancer (CRPC) but finding the optimal strategy and selecting the right patient is still fraught with challenges and difficulties, according to uro-oncology experts during a thematic session at the 29th Annual EAU Congress in Stockholm, Sweden.

“ ‘With many prostate cancer patients hoping for a better life without symptoms of the disease, the aim is to identify which new drugs, or a combination of these drugs, can offer prolong survival or effectively palliate bone disease,’ said Prof. Maria De Santis who chaired Thematic Session 10.

“The session focussed on castration-resistant prostate cancer (CRPC) which is often considered one of the toughest challenges in uro-oncology since despite repeated treatments the disease accelerates or progresses with severe impact on quality of life (QoL).”

Editor’s note: This article is about an event at a urology conference in Sweden. During the event, participants discussed the latest in prostate cancer treatment, with a focus on castration-resistant prostate cancer (CRPC).

Scientists Refine and Develop New Strategies to Target Bone Metastases

Metastasis is responsible for most cancer deaths, but the organs to which specific types of cancers migrate differ. Prostate cancers tend to metastasize to bone tissue, causing bone-related complications. The symptoms of bone metastases can be very painful and disruptive. Fortunately, some patients can benefit from therapies developed specifically to treat these complications. Continue reading…