Bone-Targeted Therapy for Metastatic Prostate Cancer

Introduction to Bone-Targeted Therapy

• The European Society for Medical Oncology (ESMO) guidelines recommend denosumab or zoledronate in patients with castration-resistant prostate cancer (CRPC) and bone metastases, whether symptomatic or not, with Level I, Grade A evidence 1, 2
• The National Comprehensive Cancer Network (NCCN) guidelines support denosumab 120 mg subcutaneously every 4 weeks as a category 1 recommendation for prevention of skeletal-related events (SREs) in metastatic CRPC 3

Denosumab vs Zoledronic Acid

• Denosumab 120 mg demonstrated superiority over zoledronic acid in delaying time to first SRE by a median of 8.2 months in patients with metastatic prostate cancer 4

Monitoring Requirements

• Mandatory pre-treatment and monitoring requirements for denosumab include serum calcium measurement, vitamin D level assessment, calcium supplementation, and baseline dental examination 2, 3, 5
• The American College of Clinical Pharmacy and other organizations recommend avoiding invasive dental procedures during denosumab treatment; if necessary, defer denosumab until complete healing 3, 5

Treatment Duration and Discontinuation

• ESMO guidelines note that discontinuation of denosumab may be considered for patients with oligometastatic bone disease in remission, though this is not routinely recommended 2
• If denosumab is discontinued for >6 months, bisphosphonate treatment (e.g., zoledronic acid) is recommended to suppress rebound osteolysis 2