Skeletal Complications of GU Malignancies Optimizing Treatment With Bisphosphonates

1
Skeletal Complications of GU MalignanciesOptimiz
ing Treatment With Bisphosphonates

• Kurt Miller
• Professor and Chairman of UrologyBenjamin
  Franklin Medical CenterBerlin, Germany

2
Metastatic Bone Disease Is Prevalent
5-year world prevalence,thousands1
Incidence of bone metastases in cancers, 2
Disease
Breast
65 - 75
4,406
Prostate
2,369
65 - 75
1,362
30 - 40
Lung
Bladder
1,110
40
14 - 45
643
Melanoma
586
20 - 25
Renal
Myeloma
183
70 - 95
1. Ferlay J, et al. In GLOBOCAN 2002. 2004.
2. Coleman RE. Cancer Treat Rev. 200127165-176.
3
Skeletal-Related Events (SREs) Are Frequently
Observed in Prostate Cancer Patients Without BP
Treatment
Total SREs
60
Radiation therapy
49
Pathologic fracture
50
Spinal cord compression
Surgical intervention
40
33
30
25
Patients with an SRE,
20
8
10
4
0
n 208
24-month data from placebo arm of randomized
study. Saad F, et al. Am Urol Assoc. 2003. Abstra
ct 1472.
4
Pathologic Fractures Increase the Risk of
Mortality
Riskincrease
P value
1.23
23
.10
Prostate cancer1
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
1.8
2
Hazard ratio (patients)
Decreased mortality
Increased mortality
1. Data from Saad F, et al. Presented at ECCO
October 30-November 3, 2005 Paris, France.
Abstract 1265.
5
Skeletal Morbidity in Patients With Bone
Metastases From Renal Cell Carcinoma

• Bone metastases are typically osteolytic
• Median survival from diagnosis of bone metastases
  is 1 year
  
• Patients are at extremely high risk for skeletal
  complications
  
• 80 of patients experienced an SRE
• 60 had a pathologic fracture
• 60 required radiation to bone to palliate bone
  pain
  
• Bone metastases are aggressive with a short
  median time to progression of 3 months

Coleman RE. Cancer. 1997801588-1594.
Lipton A, et al. Cancer, 200398962-969. Lipton
A, et al. Seventh Workshop on Bisphosphonates,
2004. Abstract 28.
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Skeletal Morbidity in Patients With Bone
Metastases From Bladder Cancer

• Aggressive cancer relapse in bone is common1
• Median survival after relapse is approximately20
  months
  
• Strong predilection for metastasis to bone
• Approximately 30 of metastatic sites
  predominantly pelvis and spine1,2
  
• Most common cause of pelvic and lower-back pain3
• Potentially disabling spinal cord compression3

1. Spiess PE, et al. Urol Oncol. 20072538-43.
2. Punyavoravut V and Nelson SD. J Med Assoc
Thai. 199982839-43.3. Anderson TS, et al.
Cancer. 2003972267-72.
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Topics

• Diagnosing and treating bone disease in patients
  with genitourinary cancer
  
• Early and long-term benefits of bone health
  management
  
• Prevention of SREs with zoledronic acid
• New guidelines and their implementationin
  practice
  
• Investigational indications

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Treatment Patterns in the Prostate Cancer Setting

• Multiple international guidelines and
  multidisciplinary consensus recommendations have
  been published for treating bone metastases in
  patients with prostate cancer
• Despite the presence of these guidelines,
  screening practices and treatments are
  inconsistent

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Agenda

• Kurt Miller Urologic Clinic, Charite Campus
  Benjamin Franklin, Berlin, GermanyChairman
  
• Daniel Petrylak Columbia University Medical
  Center, New York, New York, USARisk Factors for
  the Development of Bone Metastases in Prostate
  Cancer
• Fred Saad University of Montreal, Montreal,
  Quebec, CanadaBisphosphonates Can Prevent
  Skeletal Complications from Prostate Cancer and
  Renal Cell Carcinoma
• Bob Djavan University of Vienna, Vienna,
  AustriaNew York University, New York, USANew
  Tools for the Urologist in the Management of Bone
  Metastases