Lisa Horvath, PhD, MBBS

Invited study discussant Lisa Horvath, PhD, MBBS, a medical oncologist at Chris O’Brien Lifehouse, University of Sydney, Australia, commented on the results of the EORTC 1333/PEACE III trial: “It was good to see the fracture rate in the radium-223 arm did, in fact, improve. However, what I found most impressive was the efficacy of bone-protecting agents in the standard-of-care enzalutamide arm. The investigators used zoledronic acid or denosumab at metastatic castration-resistant prostate cancer doses as per the European guidelines,” she continued.

Prof. Horvath emphasized that the study showed how an independent data monitoring committee can improve outcomes. Fracture rates were reduced in both arms of the study after mandated use of bone-protecting agents was implemented.

Osteonecrosis of the Jaw

Limitations of this analysis were that it was a nonrandomized comparision, had a small numbers of patients, and provided no data on toxicity or quality of life. “However, this analysis does address one of the great fears of medical oncologists: osteonecrosis of the jaw,” continued Prof. Horvath.

Concern about osteonecrosis of the jaw resulting from the use of bone-protecting agents should be balanced against the benefit in reducing the rate of fracture. “Reducing the 1-year fracture rate from 15.6% to 2.6% proves the point that we should be using these agents more frequently,” she stated. 

DISCLOSURE: Prof. Horvath reported relationships with Connected Medical Solutions, Imagion Biosystems, Astellas Pharma, Janssen-Cilag, and Pfizer.