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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