Management of Bone Metastases in Patients with Castration-Resistant Prostate Cancer

Cathomas, Richard; Bajory, Zoltán; Bouzid, Mounira; Ghoneimy, Ahmed Mohamed El; Gillessen, Silke; Gonçalves, Frederico; Kacsó, Gabriel; Kramer, Gero; Milecki, Piotr; Pacík, Dalibor; Tantawy, Wahid; Lesniewski-Kmak, Krzystof

doi:10.1159/000358258

Cited by 26 publications

(32 citation statements)

References 74 publications

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“…There are data that conventional radiotherapy may effectively control pain and prevent pathologic fractures in this situation [13,14]. Stereotactic radiotherapy for oligometastases has been suggested to prolong the time before androgen deprivation treatment needs to be implemented [15] (fig.…”

Section: Prostate Cancermentioning

confidence: 99%

Treatment of Bone Metastases in Urologic Malignancies

Froehner¹,

Hölscher

Hakenberg

et al. 2014

Urol Int

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The skeletal system is the most common site of metastatic cancer spread. Bone metastases are often associated with severe morbidity, pain and functional impairment. Timely diagnosis and proper treatment may decrease morbidity, improve quality of life and in some cases even improve survival. External beam radiotherapy may effectively give pain relief in patients with painful bone metastases. In bone metastases from castration-resistant prostate cancer or urothelial bladder cancer, treatment with zoledronic acid or denosumab may reduce skeletal-related events. In contrast to castration-resistant prostate cancer, in patients with bone metastases from bladder cancer such treatment may even improve survival. On the other hand, the efficacy of these agents is questionable in patients with bone involvement from metastatic renal cell carcinoma or germ cell tumors. When bisphosphonates or denosumab are considered in such cases, the potential benefits of treatment should be critically weighed against the risk of side effects. In germ cell tumors, bone metastases may be cured by cisplatin-based chemotherapy, however, there are only limited data on the specific management of residual disease. Oligometastases may be treated by stereotactic radiotherapy or - especially in patients with renal cell carcinoma - by surgical resection and endoprosthetic replacement. Limited data are available on the management of bone involvement in germ cell tumors. Decisions on the resection or local radiotherapy of residual disease should be individualized considering the overall response and the feasibility and risks of resection.

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Section: Prostate Cancermentioning

confidence: 99%

Treatment of Bone Metastases in Urologic Malignancies

Froehner¹,

Hölscher

Hakenberg

et al. 2014

Urol Int

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“…7 Bone metastases are associated with increased mortality, 8,9 as well as increased disability, pain, and impaired QOL. [10][11][12] Up to half of patients with mCRPC will develop bone pain and other skeletal-related complications during the course of their disease, such as pathologic fractures, spinal cord or nerve root compression, surgery to bone, or palliative radiation to bone. 7,13 Still, symptoms are often under-recognized and patients may be hesitant to communicate symptoms to their health care providers.…”

Section: Introductionmentioning

confidence: 99%

Symptom assessment to guide treatment selection and determine progression in metastatic castration-resistant prostate cancer: Expert opinion and review of the evidence

Saad

Pouliot

Danielson

et al. 2018

CUAJ

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Multiple new agents to treat metastatic castration-resistant prostate cancer (mCRPC) have become available in recent years; however, the appropriate timing and sequencing of these agents have yet to be elucidated. Until accurate biomarkers become available to allow more focused therapeutic targeting for this population, treatment selection for men with mCRPC will continue to be driven largely by close assessment of patient-related factors and symptoms. Pain, as the predominant symptom of mCRPC, is often the focus when assessing progression and the need for a change in treatment. A myriad of other symptoms, including fatigue, impact on activities of daily living, sleep, and lower urinary tract symptoms, also affect men with mCRPC, and assessment of the composite of these symptoms provides an earlier signal for the need to adjust treatment. A number of tools are available for assessing symptoms in patients with advanced prostate cancer, but they are not used routinely used, given their complexity and length. A new simplified questionnaire is proposed for the assessment of symptoms, beyond pain, to inform treatment decisions for men with mCRPC.

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“…3). Metastases are present in at least 80% of men with CRPC, with bone a preferred metastatic site and skeletal-related events (SRE) such as bone pain, fractures, spinal cord compression, and vertebral collapse being common (4,5). SREs are associated with increased mortality risk and health care costs, and decreased quality of life (4,6).…”

Section: Introductionmentioning

confidence: 99%

“…Several treatment options are available for the management of metastatic CRPC (mCRPC), including radiotherapy, hormonal therapies, and cytotoxic agents (4). The cytochrome P17 antagonist abiraterone and androgen receptor blocker enzalutamide, which both improve overall survival (OS), have recently been approved by the Food and Drug Administration (7,8) and the European Medicines Agency (9,10) for the treatment of patients with mCRPC (11).…”

Section: Introductionmentioning

confidence: 99%

Differential Effect on Bone Lesions of Targeting Integrins: Randomized Phase II Trial of Abituzumab in Patients with Metastatic Castration-Resistant Prostate Cancer

Hussain

Moulec

Gimmi

et al. 2016

Clinical Cancer Research

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on behalf of the PERSEUS Study Group Abstract Purpose: Integrins play a critical role in the progression of prostate cancer and its bone metastases. We investigated the use of the pan-av integrin inhibitor abituzumab in chemotherapy-na€ ve patients with asymptomatic or mildly symptomatic metastatic castration-resistant prostate cancer.Experimental Design: PERSEUS (NCT01360840) was a randomized, double-blind phase II study. Men with pathologically confirmed prostate cancer and radiologic progression of bone lesions in the 28 days prior to randomization were assigned to receive abituzumab 750 mg or 1,500 mg or placebo (1:1:1) every 3 weeks in combination with luteinizing hormone-releasing hormone agonist/antagonist therapy. The primary endpoint was progression-free survival (PFS).Results: The intent-to-treat population comprised 180 patients, 60 in each arm. The primary endpoint of PFS was not significantly different with abituzumab-based therapy compared with placebo [abituzumab 750 mg, 3.4 months, HR ¼ 0.89; 95% confidence interval (CI), 0.57-1.39; abituzumab 1,500 mg, 4.3 months, HR ¼ 0.81; 95% CI, 0.52-1.26; placebo, 3.3 months], but the cumulative incidence of bone lesion progression was lower with abituzumab than with placebo for up to 24 months (cumulative incidence 23.6% vs. 41.1% at 6 months, 26.1% vs. 45.4% at 12 months). Two partial tumor responses were observed (1 abituzumab 1,500 mg and 1 placebo). Approximately 85% to 90% of patients experienced at least one treatment-emergent adverse event (TEAE) in the different arms, but the incidences of serious TEAEs and TEAEs with fatal outcome were similar in the three arms.Conclusions: Although PFS was not significantly extended, abituzumab appears to have specific activity in prostate cancerassociated bone lesions that warrants further investigation. Clin Cancer Res; 22(13); 3192-200. Ó2016 AACR.

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Management of Bone Metastases in Patients with Castration-Resistant Prostate Cancer

Cited by 26 publications

References 74 publications

Treatment of Bone Metastases in Urologic Malignancies

Treatment of Bone Metastases in Urologic Malignancies

Symptom assessment to guide treatment selection and determine progression in metastatic castration-resistant prostate cancer: Expert opinion and review of the evidence

Differential Effect on Bone Lesions of Targeting Integrins: Randomized Phase II Trial of Abituzumab in Patients with Metastatic Castration-Resistant Prostate Cancer

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