Novel Bone-Targeting Agents in Prostate Cancer
This is an exciting time to treat patients with PC as multiple new bone-targeting drugs are now approved or being tested in clinical trials. Monthly therapy with either ZA or denosumab has been shown to reduce the risk for SREs in men with CRPC metastatic to bone. When the two agents were compared directly, denosumab was superior. Supplementation of calcium and vitamin D in all men receiving ADT is recommended by current National Comparative Cancer Network guidelines. More recently, radium-223 was the first bone-targeting agent to demonstrate improvement in OS in patients with metastatic CRPC. Future studies will explore important unanswered questions such as the added benefit of ZA or denosumab in the context of newer systemic therapies and the combination or the sequence of these novel therapies in mCRPC. For example, the combination of radium-223 with hormonal therapy such as abiraterone and or enzalutamide offers a good opportunity to target both bone and visceral metastasis. Also the combination of radium with denosumab has not been explored. These and other novel bone-targeting PC drugs in development provide hope for continued improvements in PC patient clinical outcomes.
Conclusions
This is an exciting time to treat patients with PC as multiple new bone-targeting drugs are now approved or being tested in clinical trials. Monthly therapy with either ZA or denosumab has been shown to reduce the risk for SREs in men with CRPC metastatic to bone. When the two agents were compared directly, denosumab was superior. Supplementation of calcium and vitamin D in all men receiving ADT is recommended by current National Comparative Cancer Network guidelines. More recently, radium-223 was the first bone-targeting agent to demonstrate improvement in OS in patients with metastatic CRPC. Future studies will explore important unanswered questions such as the added benefit of ZA or denosumab in the context of newer systemic therapies and the combination or the sequence of these novel therapies in mCRPC. For example, the combination of radium-223 with hormonal therapy such as abiraterone and or enzalutamide offers a good opportunity to target both bone and visceral metastasis. Also the combination of radium with denosumab has not been explored. These and other novel bone-targeting PC drugs in development provide hope for continued improvements in PC patient clinical outcomes.
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