1. A phase III multicenter, randomized, controlled study of combined androgen blockade with versus without zoledronic acid in prostate cancer patients with metastatic bone disease: results of the ZAPCA trial.
- Author
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Kamba, Tomomi, Kamoto, Toshiyuki, Maruo, Shinichiro, Kikuchi, Takashi, Shimizu, Yosuke, Namiki, Shunichi, Fujimoto, Kiyohide, Kawanishi, Hiroaki, Sato, Fuminori, Narita, Shintaro, Satoh, Takefumi, Saito, Hideo, Sugimoto, Mikio, Teishima, Jun, Masumori, Naoya, Egawa, Shin, Sakai, Hideki, Okada, Yusaku, Terachi, Toshiro, and Ogawa, Osamu
- Subjects
ANDROGENS ,ZOLEDRONIC acid ,BONE metastasis ,KAPLAN-Meier estimator ,PATIENTS ,THERAPEUTICS - Abstract
Objective: To examine the antitumor activity of zoledronic acid (ZA) combined with androgen deprivation therapy (ADT) for men with treatment-naive prostate cancer and bone metastasis. Methods: We enrolled 227 men with treatment-naive prostate cancer and bone metastasis. Participants were randomly assigned (1:1 ratio) to receive combined androgen blockade alone (CAB group) or ZA with combined androgen blockade (CZ group). Time to treatment failure (TTTF), time to the first skeletal-related event (TTfSRE), and overall survival (OS) rates were estimated using the Kaplan-Meier method. Hazard ratios (HRs) were calculated using the Cox proportional hazards model. Median follow-up duration was 41.5 months. Results: Median TTTFs were 12.4 and 9.7 months for the CZ and CAB groups, respectively (HR 0.75; 95 % CI 0.57-1.00; p = 0.051). For men with baseline prostate-specific antigen levels <200 ng/mL, median TTTFs were 23.7 and 9.8 months for the CZ and CAB groups, respectively (HR 0.58; 95 % CI 0.35-0.93; p = 0.023). Median TTfSREs were 64.7 and 45.9 months for the CZ and CAB groups, respectively (HR 0.58; 95 % CI 0.38-0.88; p = 0.009). OS was similar between the groups. Conclusions: This study failed to demonstrate that combined use of ZA and ADT significantly prolonged TTTF in men with treatment-naive prostate cancer and bone metastasis. However, it generates a new hypothesis that the combined therapy could delay the development of castration resistance in a subgroup of patients with low baseline prostate-specific antigen values <200 ng/mL. The treatment also significantly prolonged TTfSRE but did not affect OS. [ABSTRACT FROM AUTHOR]
- Published
- 2017
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