Bone metastases: biology, treatment and palliation Highlights from ASCO-GU 2016 Salvatore Grisanti Francesca Valcamonico, Alberto Dalla Volta & Alfredo Berruti Oncologia Medica Università degli Studi & Spedali Civili di Brescia AIOM Post ASCO-GU review, Milano 22 novembre 2016
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Bone metastases: biology, treatment and palliation
Highlights from ASCO-GU 2016
Salvatore Grisanti
Francesca Valcamonico, Alberto Dalla Volta & Alfredo Berruti
Oncologia Medica
Università degli Studi & Spedali Civili di Brescia
AIOM Post ASCO-GU review, Milano 22 novembre 2016
Disclosure of potential conflict of interest
Dr. Grisanti has served as member of a Veridex European Advisory Board, Hamburg, May 2011
Bone metastases in GU neoplasms Neoplasm Frequency (%) Ref
Prostate >75 Coleman RE. Clin Cancer Res. 2006
Kidney 35-40 Woodward et al. Bone 2011
Bladder 12-35 Zaghloul et al. Int J Clin Oncol. 2010
Testis GCT <1 Jamal-Hanjani et al. BJU Int. 2013
Penis <1 Braumann et al. Case Rep Urol. 2015
Outline of highlights ASCO GU 2016 (bone)
• What is the place of Biphosphonates/Zoledronic acid after the STAMPEDE trial and meta-analysis (Lancet Oncol dec 2015)?
• Alpha-emitters particles (Radium-223)
• Imaging of bone metastases (M. Rizzo)
• Biology & Biomarkers for bone targets/activity & selection of patients
Interpretation: No evidence exists to suggest that zoledronic acid improves survival in men with M1 or M0 disease, and any potential benefit is probably small.
Vale CL et al. Lancet Oncol. 2015
Biphosphonates + SOC in M1 pts
Biphosphonates + SOC in M0 pts
Zoledronic acid + SOC in M1 pts
Zoledronic acid + SOC in M0 pts
What after the STAMPEDE trial? Study hypothesis: Early use of therapies may give larger absolute benefit in OS
Supplement to dx.doi.org/10.1016/S0140-6736(15)01037-5
| Page 2
Supplem ental Figure 1 : Overall t r ia l design
Domanda ECM: Celecoxib non è un trattamento riconosciuto per le M+ ossee
Take home: • ZA non aumenta il clinical outcome in HSPC • Osteoclast-therapy non dovrebbe essere usata in HSPC per
prevenire SRE
Take home: • BTT può avere effetto additivo ad Abiraterone • Ma si tratta di un’analisi post-hoc
Mechanism of action of Radium-223
1. R223 mimics calcium and is incorporated in areas of new bone formation (complexes of hydroxyapatite) 2. R223 emits alpha-particles with high efficiency (multiple double-strands DNA breaks) and in a short range
(<10 cell diameter)
Re-treatment with Radium-223: 6 + 6 injections?
What is the difference between a “winner” and a “loser”?