Bone pain linked to survival in hormone-sensitive prostate cancer

By Selina Wellbelove

10 Jul 2024

Bone pain has been linked with worse survival outcomes in patients with metastatic, hormone-sensitive prostate cancer (MHSPC), a finding that researchers believe could potentially lead to more personalised treatment approaches.

According to a post-hoc secondary analysis of data from the US-based SWOG-1216 trial, patients with bone pain at diagnosis fared significantly worse than those without on a number of key measures, including overall survival and PSA response.

The findings “highlight the need to consider bone pain in prognostic modelling, treatment selection, patient monitoring, and follow-up and suggest prioritising these patients for clinical trials and immediate systemic treatment initiation,” the authors reported in JAMA Network Open (link here).

The analysis included 1,279 patients newly diagnosed MHSPC, who were randomised in the trial to receive either androgen deprivation therapy (ADT) with orteronel or ADT with bicalutamide, until disease progression or unacceptable toxicity.

Patients with bone pain at baseline were found to be younger at diagnosis (median age 66 versus 68 years; p=0.02); have a greater incidence of high volume disease (70% vs 42%); and also have higher median PSA values (61.5ng/mL (µg/L) vs 22.9 ng/mL (µg/L); p=<0.001).

After a median follow-up of four years, progression-free survival (PFS) was significantly shorter in patients who experienced bone pain at diagnosis compared to those who did not (1.3 years versus 3.7 years, adjusted hazard ratio [AHR] 1.46; p=0.001).

This was also the case for overall survival, which was 3.9 years versus not reached (AHR 1.66; p=0.001).

Among patients 227 patients with baseline bone pain and PSA data, 46% had a complete PSA response and 20% had no response after seven months, compared with 66% and 8%, respectively, of 760 patients with available PSA levels who did not have baseline bone pain respectively (p=<0.001).

There were some key limitations with the research that were highlighted by the study authors, including the post hoc nature of the trial and that orteronel failed to have a significant impact on overall survival and did therefore not receive subsequent regulatory approval.

“However, bone pain was associated with poor outcomes regardless of the treatment arm in our current analysis and therefore may have implications in the management of MHSPC,” they stressed.

The authors also noted that multiple prior studies have already linked the presence of bone pain with worse survival outcomes in patients with castration-resistant prostate cancer, and suggest that the association could be down to the presence of nerve growth factor in the tumour, as this can mediate both pain and tumour growth.

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