Genitourinary Cancer

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SU_32_2328 - Fracture Rate and Overall Survival in mCRPC Patients Treated with Radium-223 and Concomitant Abiraterone.

Sunday, October 21
1:15 PM - 2:45 PM
Location: Innovation Hub, Exhibit Hall 3

Fracture Rate and Overall Survival in mCRPC Patients Treated with Radium-223 and Concomitant Abiraterone.
J. Schiff1,2, E. Ledet2, P. M. Cotogno2,3, and O. Sartor2; 1Tulane University School of Medicine, New Orleans, LA, 2Tulane Cancer Center, New Orleans, LA, 3Office of Clinical Research Tulane University, New Orleans, LA

Purpose/Objective(s):

Both radium-223 (Ra) and abiraterone/prednisone (Abi/Pred) prolong overall survival (OS) in metastatic castrate resistant prostate cancer (mCRPC). Recent prospective randomized data (ERA-223 trial) combining Abi/Pred and Ra (starting simultaneously) in mCRPC patients (pts) indicate that this combination increases fractures and deaths compared to Abi/Pred alone. In ERA-223, risks were partially mitigated by bone health agents (BHA) (i.e denosumab). Herein we analyzed our institutional pts to assess fractures/OS in pts treated with Ra +/- Abi/steroid (Abi/S).

Materials/Methods:

After IRB approval, all pts in our institutional database were assessed for fractures/OS provided that they received Ra therapy between 2010 and 2017 and had one or more CT, MRI, or bone scan performed post-Ra. Categorical data were analyzed by chi-square. OS was evaluated using KM and log-rank calculations. 

Results:

Of 82 identified pts, 12 (13%) had radiographically documented fractures. Fracture data is summarized in Table 1. 40 (49%) of the Ra pts were treated with concomitant Abi/S, and 7 (17.5%) had fractures as compared to 5 (12%) pts of the 42 (51%) Ra pts treated with no Abi/S. Of the 82 pts, 34 (41%) also received BHA and 5 (15%) had fractures. There were 48 (59%) pts not receiving BHA and 7 (15%) had fractures. In the Ra group without Abi/S, 10 (12%) pts received BHA and 1 (10%) of these patients had a fracture. Within the Ra + Abi/S group, 10 (12%) pts were started on Ra and Abi/S simultaneously and 3 (30%) of these pts had fractures. Non-simultaneous Ra and Abi/S fracture rates were 4/30 (13%). None of the fracture data were statistically distinct between groups. Overall, pts on Ra and Abi/S had better OS (median 727 days) compared to pts on Ra without Abi/S (353 days, p=.0346).

Conclusion: Fractures rates are higher in pts with imaging as compared to ALSYMPCA. The highest fracture rates we observed were with pts simultaneously starting Ra and Abi/S. Survival analyses are likely biased when evaluating Abi/S as a univariate factor. Larger data sets are required to provide sample sizes adequate for appropriately powered statistical analyses.

Category

N

Number of patients with fractures

Patients on BHA? (X=All Inclusive)

Total patients

82

12 (15%)

X

Patients on Ra and Abi/S regardless of BHA status

40

7 (18%)

X

Patients on Ra, no Abi/S regardless of BHA status

42

5 (12%)

X

Patients on Ra and Abi/S and BHA

24

4 (17%)

Yes

Patients on Ra and Abi/S and no BHA

16

3 (19%)

No

Patients on Ra and Abi/S started simultaneously

10

3 (30%)

X

Patients on Ra and Abi/S started previously

30

4 (13%)

X

Patients on Ra, no Abi/S and BHA

10

1 (11%)

Yes

Patients on Ra, no Abi/S and no BHA

32

4 (13%)

No

Table 1. Fracture rate in patients on Ra +/- Abi/S +/-BHA

Author Disclosure: J. Schiff: None. E. Ledet: None. P.M. Cotogno: None. O. Sartor: Independent Contractor; FINO. Research Grant; Bayer. Consultant; AstraZeneca, Bellicum, Bristol-Myers Squibb, Celegne, Dendreon, EMD Serono, Johnson & Johnson, Oncogenex, Pfizer, Sanofi-Aventis, Bayer. Stock; GSK, JNJ, Lilly. GU Committee Medical Oncology Chair; NRG.

Joshua Schiff, BS

Biography:
My name is Joshua Schiff, and I am a fourth-year student at the Tulane University School of Medicine applying to Radiation Oncology during the 2019 ERAS cycle. My current interests include the management of metastatic castrate-resistant prostate cancer, brachytherapy, and the use of palliative radiation therapy. However, I look forward to broadening my interests in residency and am excited to learn about all aspects of radiation therapy. I have researched multiple areas within the prostate cancer space, and my current project focuses on detecting whether there is an effect on the fracture rate and overall survival in patients treated with Radium-223 and Abiraterone simultaneously vs. Abiraterone alone.

Presentation(s):

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