Symptomatic Skeletal Events and the Use of Bone Health Agents in a Real-World Treated Metastatic Castration Resistant Prostate Cancer Population: Results From the CAPRI-Study in the Netherlands.

Patients with metastatic castration resistant prostate cancer (mCRPC) are at risk of symptomatic skeletal events (SSE). Bone health agents (BHA, ie bisphosphonates and denosumab) and new life-prolonging drugs (LPDs) can delay SSEs. The aim of this study is to investigate the use of BHAs in relation to SSEs in treated real-world mCRPC population.

We included patients from the CAPRI registry who were treated with at least one LPD and diagnosed with bone metastases prior to the start of first LPD (LPD1). Outcomes were SSEs (external beam radiation therapy (EBRT) to the bone, orthopedic surgery, pathologic fracture or spinal cord compression) and SSE-free survival (SSE-FS) since LPD1.

One-thousand nine hundred and twenty-three patients were included with a median follow-up from LPD1 of 16.7 months. Fifty-two percent (n = 996) started BHA prior or within 4 weeks after the start of LPD1 (early BHA). In total, 41% experienced at least one SSE. SSE incidence rate was 0.29 per patient year for patients without BHA and 0.27 for patients with early BHA. Median SSE-FS from LPD1 was 12.9 months. SSE-FS was longer in patients who started BHA early versus patients without BHA (13.2 vs. 11.0 months, P = .001).

In a real-world population we observed an undertreatment with BHAs, although patients with early BHA use had lower incidence rates of SSEs and longer SSE-FS. This finding was irrespective of type of SSE and presence of risk factors. In addition to LPD treatment, timely initiation of BHAs is recommended in bone metastatic CRPC-patients with both pain and/or opioid use and prior SSE.

Clinical genitourinary cancer. 2021 Nov 02 [Epub ahead of print]

Malou C P Kuppen, Hans M Westgeest, Alfons J M van den Eertwegh, Reindert J A van Moorselaar, Inge M van Oort, Metin Tascilar, Niven Mehra, Jules Lavalaye, Diederik M Somford, Katja K H Aben, Andre M Bergman, Ronald de Wit, A C M Fons van den Bergh, Carin A Uyl- de Groot, Winald R Gerritsen

Institute for Medical Technology Assessment, Erasmus School of Health Policy and Management, Rotterdam, the Netherlands. Electronic address: ., Department of Internal Medicine, Amphia Hospital, Breda, the Netherlands., Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands., Department of Urology, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands., Department of Urology, Radboud University Medical Center, Nijmegen, the Netherlands., Department of Internal Medicine, Isala, Zwolle, the Netherlands., Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands., Department of Nuclear Medicine, St Antonius Hospital, Nieuwegein, the Netherlands., Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands., Department for Health Evidence, Radboud university medical center, Nijmegen, the Netherlands; Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands., Division of Medical Oncology, the Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands., Department of Medical Oncology, Erasmus MC Daniel den Hoed Cancer Center, Rotterdam., Department of Radiation Oncology, University Medical Center Groningen, Groningen, the Netherlands., Institute for Medical Technology Assessment, Erasmus School of Health Policy and Management, Rotterdam, the Netherlands.