Patients with bone metastases should receive bone-targeting therapy. Either denosumab or zoledronic acid can be used in this setting, as Fizazi and colleagues demonstrated that denosumab was non-inferior to zoledronic acid for time to first skeletal-related event in men with CRPC and no previous exposure to intravenous bisphosphonate.
The TRAPEZE trial demonstrated that bone-directed therapies for bone metastatic CRPC had no effect on overall survival or progression-free survival in unadjusted analyses; however, analysis adjusted for all stratification variables did identify a benefit for strontium-89 on clinical progression-free survival and zoledronic acid for skeletal free interval.
ONJ is a rare toxicity of bone-targeting therapy; its incidence is 1%-2%, per the NCCN. Most of the patients who develop ONJ have preexisting dental problems. The NCCN recommends supplemental calcium and vitamin D for patients receiving bone-targeting therapy.
Learn more about bone-targeted therapy.
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Cite this: Evelyn S. Marienberg. Fast Five Quiz: Castration-Resistant Metastatic and Advanced Prostate Cancer Management - Medscape - Nov 08, 2022.