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Bone is the most common metastatic site for prostate cancer
.
Bone metastasis of prostate cancer seriously affects the quality of life of patients, and significantly shortens the survival time of patients, which is an urgent clinical problem to be solved
.
Disulumab is the first precisely targeted RANKL inhibitor.
Compared with zoledronic acid, it can significantly delay the onset of bone-related events (SRE) and the time of bone pain exacerbation, which can bring more benefits to patients.
Benefit [1]
.
Bone metastasis and current status of prostate cancer [2] Bone is the most important metastasis site of prostate cancer.
Early prostate cancer usually has no symptoms, and some advanced patients seek medical treatment due to bone pain
.
Bone metastasis occurs in more than 3/4 of prostate cancer patients, and bone metastasis occurs in about 50% of patients when they are first diagnosed
.
Prostatic bone metastases are more common in the pelvis, followed by the spine.
Skull metastases are rare.
Among the peripheral bones, they are most easily transferred to the limb bones, and the femur is the most common
.
Bone metastases can cause symptoms such as pathological fractures and spinal cord compression
.
Among patients with metastatic castration-resistant prostate cancer, more than 80% of patients have bone metastases
.
73% of prostate cancer patients with bone metastases have had severe bone pain at the time of diagnosis, and 70% of patients need to receive bone-targeted drug treatment
.
How to treat and prevent prostate cancer bone metastasis? [2] The purpose of treating bone metastases is mainly to relieve the pain caused by bone metastases, improve the quality of life of patients, and prevent and reduce the occurrence of bone-related events
.
Treatment methods include drug therapy, analgesia therapy, external radiation therapy, radionuclide therapy, orthopedic surgery, and minimally invasive interventional therapy
.
Drug therapy Endocrine therapy is the most basic treatment method in the treatment of distant metastasis of prostate cancer
.
Androgen deprivation therapy (ADT) is the basic treatment for bone metastatic prostate cancer
.
Endocrine therapy include: simple surgical or medical castration, androgen receptor inhibitor therapy, androgen biosynthesis inhibitors
.
Chemotherapy and targeted therapy are also one of the main treatments for bone metastasis of prostate cancer
.
While actively treating the primary lesions, how to reduce and prevent bone metastases and bone-related events is particularly important
.
Anti-bone resorption therapy is an important treatment method proven by evidence-based medicine to prevent bone-related events
.
The NCCN prostate cancer clinical practice guidelines recommend that if patients with prostate cancer have bone metastases, anti-bone resorption therapy can be used with desulumab or zoledronic acid
.
Bisphosphonates are the basic drugs for bone metastasis of malignant tumors
.
For patients with prostate cancer bone metastasis with bone pain, bisphosphonates can reduce and delay the occurrence of bone-related events in patients with metastatic castration-resistant prostate cancer bone metastases
.
Zoledronic acid is a third-generation bisphosphonate drug, mainly used to treat malignant hypercalcemia and bone metastases
.
Current studies have found that in addition to inhibiting bone resorption, zoledronic acid may have direct or indirect anti-tumor activity
.
Disulumab is a fully human monoclonal antibody against nuclear factor receptor activator κB ligand.
It is an effective osteoclast bone resorption inhibitor and can interact with nuclear factor κB (NF-κB) receptors.
Activating protein ligand (RANKL) binds to inhibit bone resorption
.
A phase III study evaluated the efficacy and safety of disulfumab versus zoledronic acid in the treatment of metastatic castration-resistant prostate cancer
.
Compared with zoledronic acid, desulzumab can significantly delay or prevent the occurrence of bone-related events.
The first bone-related event was prolonged by 3.
6 months (P=0.
008), and the average number of bone-related events was reduced by 18% (P= 0.
008)
.
Which patients are suitable for the use of desulumab? Prostate cancer patients with bone metastases, non-metastatic prostate cancer patients with high fracture risk, and people with impaired renal function
.
How is the compliance of Desulumab? When treating bone metastases from malignant tumors, the first consideration should be to delay bone-related events and pain aggravation, and to minimize the risk of renal damage.
Disulumab can reduce and delay the occurrence of bone-related events, and there is no need to monitor the patient’s renal function.
Higher sex
.
Disulumab is administered by subcutaneous injection without indwelling intravenous infusion channels, which further improves patient compliance with treatment
.
How safe is desulumab? Hypocalcemia is a common adverse reaction of desulumab
.
Osteonecrosis of the jaw is a serious adverse reaction related to bone targeted therapy
.
Treatment strategies to reduce the incidence of mandibular osteonecrosis should be considered when receiving desulumab treatment
.
Adverse drug reactions such as nausea, diarrhea, fatigue/asthenia, hypocalcemia, hypophosphatemia, headache, dyspnea, cough, and osteonecrosis of the jaw should be monitored after injection of desulumab
.
There have been reports of multiple vertebral fractures after discontinuation of desulumab treatment.
Patients with osteoporosis or a history of previous fractures should be monitored.
When discontinuation of desulumab treatment, the risk of vertebral fractures should be evaluated
.
References: [1] Clinical application specification of Disumab in patients with prostate cancer bone metastasis.
Chinese Anti-Cancer Association Urinary and Male Reproductive Tumor Professional Committee.
DOI: 10.
12151/JMCM.
2021.
03-0 [2] Prostate Cancer Bone Metastasis Multidisciplinary Expert Consensus on Diagnosis and Treatment (2020 Edition).
Prostate Cancer Group, Professional Committee of Urinary and Male Reproductive Tumors, Chinese Anti-Cancer Association.
oi:10.
3971/j.
issn.
1000-8578.
2020.
20.
2020 Contribution email: tougao@medlive.
cn
.
Bone metastasis of prostate cancer seriously affects the quality of life of patients, and significantly shortens the survival time of patients, which is an urgent clinical problem to be solved
.
Disulumab is the first precisely targeted RANKL inhibitor.
Compared with zoledronic acid, it can significantly delay the onset of bone-related events (SRE) and the time of bone pain exacerbation, which can bring more benefits to patients.
Benefit [1]
.
Bone metastasis and current status of prostate cancer [2] Bone is the most important metastasis site of prostate cancer.
Early prostate cancer usually has no symptoms, and some advanced patients seek medical treatment due to bone pain
.
Bone metastasis occurs in more than 3/4 of prostate cancer patients, and bone metastasis occurs in about 50% of patients when they are first diagnosed
.
Prostatic bone metastases are more common in the pelvis, followed by the spine.
Skull metastases are rare.
Among the peripheral bones, they are most easily transferred to the limb bones, and the femur is the most common
.
Bone metastases can cause symptoms such as pathological fractures and spinal cord compression
.
Among patients with metastatic castration-resistant prostate cancer, more than 80% of patients have bone metastases
.
73% of prostate cancer patients with bone metastases have had severe bone pain at the time of diagnosis, and 70% of patients need to receive bone-targeted drug treatment
.
How to treat and prevent prostate cancer bone metastasis? [2] The purpose of treating bone metastases is mainly to relieve the pain caused by bone metastases, improve the quality of life of patients, and prevent and reduce the occurrence of bone-related events
.
Treatment methods include drug therapy, analgesia therapy, external radiation therapy, radionuclide therapy, orthopedic surgery, and minimally invasive interventional therapy
.
Drug therapy Endocrine therapy is the most basic treatment method in the treatment of distant metastasis of prostate cancer
.
Androgen deprivation therapy (ADT) is the basic treatment for bone metastatic prostate cancer
.
Endocrine therapy include: simple surgical or medical castration, androgen receptor inhibitor therapy, androgen biosynthesis inhibitors
.
Chemotherapy and targeted therapy are also one of the main treatments for bone metastasis of prostate cancer
.
While actively treating the primary lesions, how to reduce and prevent bone metastases and bone-related events is particularly important
.
Anti-bone resorption therapy is an important treatment method proven by evidence-based medicine to prevent bone-related events
.
The NCCN prostate cancer clinical practice guidelines recommend that if patients with prostate cancer have bone metastases, anti-bone resorption therapy can be used with desulumab or zoledronic acid
.
Bisphosphonates are the basic drugs for bone metastasis of malignant tumors
.
For patients with prostate cancer bone metastasis with bone pain, bisphosphonates can reduce and delay the occurrence of bone-related events in patients with metastatic castration-resistant prostate cancer bone metastases
.
Zoledronic acid is a third-generation bisphosphonate drug, mainly used to treat malignant hypercalcemia and bone metastases
.
Current studies have found that in addition to inhibiting bone resorption, zoledronic acid may have direct or indirect anti-tumor activity
.
Disulumab is a fully human monoclonal antibody against nuclear factor receptor activator κB ligand.
It is an effective osteoclast bone resorption inhibitor and can interact with nuclear factor κB (NF-κB) receptors.
Activating protein ligand (RANKL) binds to inhibit bone resorption
.
A phase III study evaluated the efficacy and safety of disulfumab versus zoledronic acid in the treatment of metastatic castration-resistant prostate cancer
.
Compared with zoledronic acid, desulzumab can significantly delay or prevent the occurrence of bone-related events.
The first bone-related event was prolonged by 3.
6 months (P=0.
008), and the average number of bone-related events was reduced by 18% (P= 0.
008)
.
Which patients are suitable for the use of desulumab? Prostate cancer patients with bone metastases, non-metastatic prostate cancer patients with high fracture risk, and people with impaired renal function
.
How is the compliance of Desulumab? When treating bone metastases from malignant tumors, the first consideration should be to delay bone-related events and pain aggravation, and to minimize the risk of renal damage.
Disulumab can reduce and delay the occurrence of bone-related events, and there is no need to monitor the patient’s renal function.
Higher sex
.
Disulumab is administered by subcutaneous injection without indwelling intravenous infusion channels, which further improves patient compliance with treatment
.
How safe is desulumab? Hypocalcemia is a common adverse reaction of desulumab
.
Osteonecrosis of the jaw is a serious adverse reaction related to bone targeted therapy
.
Treatment strategies to reduce the incidence of mandibular osteonecrosis should be considered when receiving desulumab treatment
.
Adverse drug reactions such as nausea, diarrhea, fatigue/asthenia, hypocalcemia, hypophosphatemia, headache, dyspnea, cough, and osteonecrosis of the jaw should be monitored after injection of desulumab
.
There have been reports of multiple vertebral fractures after discontinuation of desulumab treatment.
Patients with osteoporosis or a history of previous fractures should be monitored.
When discontinuation of desulumab treatment, the risk of vertebral fractures should be evaluated
.
References: [1] Clinical application specification of Disumab in patients with prostate cancer bone metastasis.
Chinese Anti-Cancer Association Urinary and Male Reproductive Tumor Professional Committee.
DOI: 10.
12151/JMCM.
2021.
03-0 [2] Prostate Cancer Bone Metastasis Multidisciplinary Expert Consensus on Diagnosis and Treatment (2020 Edition).
Prostate Cancer Group, Professional Committee of Urinary and Male Reproductive Tumors, Chinese Anti-Cancer Association.
oi:10.
3971/j.
issn.
1000-8578.
2020.
20.
2020 Contribution email: tougao@medlive.
cn
