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Download the ESMO 2012 Abstract Book - Oxford Journals

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Annals of Oncology<br />

deaths occurred. Prospective studies to evaluate Chemo following Ra-223 are<br />

warranted.<br />

Ra-223 + BSC Placebo + BSC<br />

Parameter<br />

(n = 90)<br />

(n = 54)<br />

Median time to Chemo; days (range) 79.0 (2–667) 64.5 (2–448)<br />

Median duration Chemo; days<br />

(range)<br />

117.5 (1–809) 112.5 (1–863)<br />

Chemo = docetaxel; n (%) 63 (70.0) 39 (72.2)<br />

Docetaxel daily dose (mg); n 22 17<br />

Mean (SD) 97.8 (41.6) 102.7 (46.3)<br />

Median (min-max) 92.5 (35-150) 120.0 (30-165)<br />

Deaths on Chemo; n (%) 13 (14.4) 8 (14.8)<br />

Cause: PC and skeletal mets (± o<strong>the</strong>r<br />

mets)<br />

9 (10.0) 7 (13.0)<br />

PC with o<strong>the</strong>r mets (or mets not<br />

specified)<br />

3 (3.3) 0 (0)<br />

Cerebral hemorrhage due to trauma<br />

Cardiopulmonary failure<br />

1 (1.1) 0 (0) 0 (0) 1 (1.1)<br />

Deaths within 30 days post Chemo;<br />

n (%)<br />

5 (5.6) 2 (3.7)<br />

Cause: PC and skeletal mets<br />

(± o<strong>the</strong>r mets)<br />

3 (3.3) 2 (3.7)<br />

Bronchopneumonia Respiratory<br />

failure + pulmonary edema<br />

1 (1.1) 1 (1.1) 0 (0) 0 (0)<br />

Neutrophils; (Absolute) (x10^9/L) 88 3.6 (0.9-26.0) 47 49 4.6 (1.9-16.4) 30<br />

Baseline, n Median (min-max) 4.4 (0.5-24.4) 41 5.7 (1.6-13.1) 19<br />

Month 2, n Median (min-max) 3.8 (1.3-10.8) 23 4.6 (1.1-8.9) 12<br />

Month 4, n Median (min-max) 3.5 (0.5-6.3) 12 4.7 (1.5-12.2) 7<br />

Month 6, n Median (min-max) 3.5 (1.9-9.4) 13 3.9 (3.0-6.4) 8 4.6<br />

Month 8, n Median (min-max) 3.6 (1.1-8.9) 8 (3.0-8.5) 6 5.6<br />

Month 10, n Median (min-max)<br />

Month 12, n Median (min-max)<br />

5.0 (2.5-7.1) (2.8-8.9)<br />

BSC, best standard of care; Chemo, cytotoxic chemo<strong>the</strong>rapy; mets, metastases; PC,<br />

prostate cancer<br />

Disclosure: O. Sartor: O. Sartor has served in a consultant or advisory role for Algeta<br />

ASA and Bayer. S. Nilsson: S. Nilsson has served in a consultant or advisory role for<br />

Algeta ASA. N. Vogelzang: N. Vogelzang has served in a consultant or advisory role<br />

for and has received grant/research support from Algeta ASA and Bayer. C.G.<br />

O’Bryan-Tear: C.G. O’Bryan-Tear is employed by and has an ownership interest in<br />

Algeta ASA. K. Staudacher: K. Staudacher is employed by and has an ownership<br />

interest in Algeta ASA. J.E. Garcia-Vargas: J. Garcia-Vargas is employed by Bayer<br />

HealthCare Pharmaceuticals. J. Zou: J. Zou is employed by Bayer HealthCare<br />

Pharmaceuticals. C. Parker: C. Parker has served in a consultant or advisory role for<br />

Algeta ASA (uncompensated) and Bayer. All o<strong>the</strong>r authors have declared no conflicts<br />

of interest.<br />

937P DENOSUMAB IN PATIENTS WITH METASTATIC PROSTATE<br />

CANCER PREVIOUSLY TREATED WITH DENOSUMAB OR<br />

ZOLEDRONIC ACID: 2-YEAR OPEN-LABEL EXTENSION<br />

PHASE RESULTS FROM THE PIVOTAL PHASE 3 STUDY<br />

K. Fizazi 1 , J.E. Brown 2 , M. Carducci 3 , N.D. Shore 4 , P. Sieber 5 , F. Kueppers 6 ,<br />

L. Karsh 7 ,R.Wei 8 , C. Goessl 9<br />

1 Cancer Medicine, Institut Gustave Roussy, University of Paris Sud, Villejuif,<br />

FRANCE, 2 Medical Oncology, Cancer Research UK Clinical Centre, Universities<br />

of Leeds/Sheffield, Leeds, UNITED KINGDOM, 3 Kimmel Cancer Center, Sidney<br />

Kimmel Comprehensive Cancer Center, Baltimore, MD, UNITED STATES OF<br />

AMERICA, 4 Urology, Carolina Urologic Research Center, Myrtle Beach, SC,<br />

UNITED STATES OF AMERICA, 5 Urology and Urological Surgery, Urological<br />

Associates of Lancaster, Ltd., Lancaster, PA, UNITED STATES OF AMERICA,<br />

6 Urology, Urology Associates, Christchurch, NEW ZEALAND, 7 Clinical Research<br />

Department, The Urology Center of Colorado, Denver, CO, UNITED STATES OF<br />

AMERICA, 8 Global Biostatistical Science, Amgen Inc., Thousand Oaks, CA,<br />

UNITED STATES OF AMERICA, 9 Clinical Development, Amgen Inc., Thousand<br />

Oaks, CA, UNITED STATES OF AMERICA<br />

Background: In a phase 3, randomized, double-blinded (DB) trial (NCT00321620),<br />

subcutaneous (SC) denosumab prevented skeletal-related events (SRE) more<br />

effectively compared with intravenous (IV) zoledronic acid (ZA) in men with<br />

castration-resistant prostate cancer (CRPC) and bone metastases (Fizazi K et al.,<br />

Lancet 2011). As a result, all patients (pts) remaining on study were offered<br />

open-label (OL) denosumab in a pre-specified 2-year extension phase.<br />

Materials and methods: Pts (n = 1901) with CRPC metastatic to bone received ei<strong>the</strong>r<br />

SC denosumab 120 mg and IV placebo or IV ZA 4 mg (adjusted for renal function)<br />

and SC placebo Q4W in <strong>the</strong> DB treatment phase. OL denosumab Q4W was offered<br />

for up to 2 years to pts remaining on study. Pts declining OL treatment were<br />

followed for survival for up to 2 years after <strong>the</strong>ir last dose of investigational product<br />

in <strong>the</strong> DB treatment phase.<br />

Results: Of 323 pts completing <strong>the</strong> DB phase, 153 (87.4%) who were randomized to<br />

denosumab (here referred to as DD pts) and 128 (86.5%) randomized to ZA (here<br />

referred to as ZD pts) continued in <strong>the</strong> OL phase. Demographics were balanced<br />

between groups. Cumulative median (Q1, Q3) denosumab exposure over <strong>the</strong> entire<br />

study for DD pts was 12.0 (5.6, 21.3) months (range: 0.1 to 67.2 months). Overall,<br />

adverse events (AEs) were comparable between groups (n = 138/147 [93.9%] DD pts;<br />

n = 105/118 [89.0%] ZD pts). Twelve pts in <strong>the</strong> DD group and 7 pts in <strong>the</strong> ZD group<br />

developed osteonecrosis of <strong>the</strong> jaw (ONJ) in <strong>the</strong> OL phase, resulting in a cumulative<br />

ONJ incidence for <strong>the</strong> entire study of 3.8% for DD pts and 2.2% for ZD pts.<br />

Hypocalcemia AEs during <strong>the</strong> OL phase were balanced between groups (n = 8 DD<br />

pts; n = 5 ZD pts). Serious AEs were reported in 78 (53.1%) DD pts and 63 (53.4%)<br />

ZD pts. Median (95% CI) overall survival over <strong>the</strong> entire study was similar<br />

between groups: 19.4 months (17.8 to 21.0) for DD pts, 19.3 months (18.0 to 20.6)<br />

for ZD pts.<br />

Conclusion: This two-year OL extension treatment phase confirmed <strong>the</strong><br />

long-term safety profile of denosumab in pts with prostate cancer metastatic to bone<br />

who received denosumab for up to 5.6 years or who switched from ZA to<br />

denosumab.<br />

Disclosure: K. Fizazi: Consultant/advisor: Amgen, Novartis, J.E. Brown: Advisory<br />

Board Member: Amgen, Novartis, Bristol Myers Squibb Corporate Sponsored<br />

Research: Novartis O<strong>the</strong>r Substantive Relationships: Consultant, Amgen, M.<br />

Carducci: Consultant/advisor: Amgen, N.D. Shore: Consultant/Advisor: Amgen,<br />

Astellas, Bayer, Dendreon, Janssen, Medivation, Sanofi Corporate Sponsored<br />

Research: Amgen, Astellas, Bayer, Dendreon, Janssen, Medivation, Sanofi, Active<br />

Biotech, BMS, Millenium, Oncogenix, Progenics, BN Immuno<strong>the</strong>rapeutics, P. Sieber:<br />

O<strong>the</strong>r substantive relationships: consultant, speaker: Amgen, R. Wei: Employee and<br />

stockholder: Amgen, C. Goessl: Employee and stockholder: Amgen. All o<strong>the</strong>r authors<br />

have declared no conflicts of interest.<br />

938P ANDROGEN DEPRIVATION AND RADIATION WITH HELICAL<br />

TOMOTHERAPY TO METASTASES IN PATIENTS WITH<br />

OLIGOMETASTATIC HORMONE - SENSITIVE PROSTATE<br />

CANCER<br />

P. Twardowski 1 ,W.Ye 2 ,S.Pal 1 , C. Arbayo 2 , M. Junqueira 1 , P. Tryon 1 , J. Wong 3<br />

1 Medical Oncology and Experimental Therapuetics, City of Hope Cancer Center,<br />

Duarte, CA, UNITED STATES OF AMERICA, 2 Biostatistics, City of Hope Cancer<br />

Center, Duarte, CA, UNITED STATES OF AMERICA, 3 Radiation Oncology, City of<br />

Hope Cancer Center, Duarte, CA, UNITED STATES OF AMERICA<br />

Background: Metastatic prostate cancer (PC) is treated with androgen deprivation<br />

<strong>the</strong>rapy (ADT) and subsequent treatments are employed only after <strong>the</strong> development<br />

of castration resistance. We hypo<strong>the</strong>sized that treatment of oligometastases with<br />

external beam radiation <strong>the</strong>rapy (EBRT) concurrent with ADT will be feasible and<br />

safe and may provide <strong>the</strong>rapeutic benefit by more effective reduction in <strong>the</strong> tumor<br />

burden.<br />

Methods: Patients (pts) with hormone sensitive PC (HSPC) and 1-5 metastases<br />

(mts) detected by bone scan and CT scan were treated with 36 weeks of LHRH<br />

agonist combined with bicalutamide and EBRT up to 45 Gy to all visible metastatic<br />

sites. Seventeen pts (59%) who had no prior <strong>the</strong>rapy of <strong>the</strong> primary tumor, also<br />

received up to 78 Gy to <strong>the</strong> prostate. Primary objectives were time to treatment<br />

failure (TTF) and toxicity. TTF was calculated from <strong>the</strong> end of <strong>the</strong>rapy until PSA<br />

reached pre-treatment level or 10 (whichever was lower) or radiographic progression<br />

or until ADT was restarted.<br />

Results: Twenty nine pts were treated. Median number of mts was 1. Median<br />

Gleason score was 8 (range 5-10). Median baseline PSA was 11.4 (range 1-74.5).<br />

Twenty one pts (72%) had bone mts, 13 pts (45%) had lymph node (LN) mts and 8<br />

pts (28%) had mts limited to pelvic LNs. Median follow up was 25.7 months (range<br />

13.4-61.4). Grade 3 toxicities included diarrhea (7%), urinary frequency (3%), renal<br />

insufficiency (3%). Twenty five pts (86%) reached PSA nadir of

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