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PEER-TO-PEER CLINICAL CONVERSATIONS |
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| Bone Health in Advanced Prostate Cancer: Findings from the STAMPEDE Trial and Hospital Episode Statistics |
| Noel Clarke, MBBS, FRCS, ChM |
| Alicia Morgans engages with Noel Clarke on the critical issue of bone health in prostate cancer patients, particularly those undergoing androgen deprivation therapy (ADT). |
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PEACE-3 Trial Results Show Promise for Radium-223 and Enzalutamide in Asymptomatic mCRPC
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Fred Saad, MD, FRCS
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| Fred Saad discusses the PEACE-3 trial results. The study compares enzalutamide plus radium-223 versus enzalutamide alone in metastatic castration-resistant prostate cancer patients with bone metastases. Dr. Saad discusses the trial's design, highlighting significant improvements in radiographic progression-free survival and overall survival with the combination therapy.
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2024 NCCN Guidelines: Preventing Skeletal Events in Prostate Cancer
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Rashid Sayyid, MD, MSc, and Zachary Klaassen, MD, MSc
Rashid Sayyid and Zach Klaassen review the NCCN prostate cancer Guideline Updates regarding the prevention of symptomatic skeletal-related events in bone metastatic CRPC patients. They discuss the efficacy and safety profiles of denosumab and zoledronic acid, highlighting key clinical trials that have shaped current recommendations.
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| The Importance of Bone Protection |
| Noel W. Clarke, MBBS, FRCS, ChM |
| Noel Clarke emphasizes the importance of bone protection in prostate cancer management, particularly for patients on lifelong ADT. Epidemiologic data highlight a significant fracture risk, with a 5-year incidence of 15% in high-risk non-metastatic and 38% in metastatic patients. Evidence from STAMPEDE trials indicates that treatment intensification with abiraterone acetate and prednisone (± enzalutamide) reduces fracture-related hospitalizations in mHSPC but shows no benefit in non-metastatic settings or when radiotherapy is added. |
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| RAPSON: Radium223-docetaxel vs Docetaxel-Radium223 Sequence in mCRPC with Prospective Biomarker Evaluation |
| Vincenza Conteduca, MD
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| The RAPSON trial examined the sequence of Radium-223 followed by docetaxel versus the reverse in patients with symptomatic bone-dominant mCRPC. Results showed that starting with Radium-223 improved quality of life and tolerability compared to starting with docetaxel, with fewer dose reductions and treatment discontinuations. However, there was no observed difference in PFS or OS between the two sequences.
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| Total and Regional Changes in Body Composition in Metastatic Hormone-Sensitive Prostate Cancer Patients Randomized to Receive Androgen Deprivation + Enzalutamide +/- Zoledronic Acid - the BonEnza Study
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| Martina Buffoni, MD
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| Martina Buffoni discusses the BonEnza trial which explored the impact of ADT plus enzalutamide, with or without zoledronic acid, on body composition in patients with mHSPC. Over 18 months, patients experienced a significant increase in fat body mass (+22.8%) and a decrease in lean body mass (-6.7%), with younger patients (<70 years) more prone to fat gain. Regional analysis revealed variability, with the largest fat increase in the arms and the greatest lean mass loss in the limbs. These findings underscore the need to monitor body composition changes and address risks of sarcopenic obesity in this population.
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| Radium-223 and Enzalutamide in Asymptomatic or Mildly Symptomatic Patients with Bone Metastatic Castration-Resistant Prostate Cancer: First Results of EORTC-GUCG 1333/PEACE-3 |
| Silke Gillessen Sommer, MD |
| The PEACE-3 trial demonstrated that adding radium-223 (223Ra) to enzalutamide significantly improved radiographic progression-free survival and overall survival in patients with bone metastatic castration-resistant prostate cancer. The combination also delayed the time to next systemic treatment and had manageable toxicity when paired with bone-protecting agents. These results support the potential of this combination as a new first-line option for mCRPC. |
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| Survival and Fracture Risk with Radium-223 Therapy in mCRPC: A Real-World Analysis
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| Hanbo Zhang, MD, FRCPC
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| This real-world analysis examined outcomes in mCRPC patients treated with radium-223. Among 92 patients, median overall survival was 9.4 months, with 39% experiencing pain relief and 57% achieving a reduction in alkaline phosphatase. Concurrent use of bone-protective agents significantly reduced pathologic fracture risk (3% vs. 26% without agents) and delayed fracture onset. The findings underscore the importance of bone-protective agents for patients receiving radium-223 therapy.
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