Safety of long-term denosumab therapy: results from the open label extension phase of two phase 3 studies in patients with metastatic breast and prostate cancer

Alison T Stopeck, Karim Fizazi, Jean Jacques Body, Janet E. Brown, Michael Carducci, Ingo Diel, Yasuhiro Fujiwara, Miguel Martín, Alexander Paterson, Katia Tonkin, Neal Shore, Paul Sieber, Frank Kueppers, Lawrence Karsh, Denise Yardley, Huei Wang, Tapan Maniar, Jorge Arellano, Ada Braun

Research output: Contribution to journalArticle

43 Citations (Scopus)

Abstract

Purpose: Zoledronic acid (ZA) or denosumab treatment reduces skeletal-related events; however, the safety of prolonged therapy has not been adequately studied. Here, we describe safety results of extended denosumab therapy in patients with bone metastases from the open-label extension phase of two phase 3 trials. Methods: Patients with metastatic breast or prostate cancer received subcutaneous denosumab 120 mg Q4W or intravenous ZA 4 mg Q4W in a double-blinded fashion. Denosumab demonstrated superior efficacy in the blinded treatment phase; thus, patients were offered open-label denosumab for up to an additional 2 years. Results: Cumulative median (Q1, Q3) denosumab exposure was 19.1 (9.2, 32.2) months in the breast cancer trial (n = 1019) and 12.0 (5.6, 21.3) months in the prostate cancer trial (n = 942); 295 patients received denosumab for >3 years. No new safety signals were identified during the open-label phase, or among patients who switched from ZA to denosumab. During the blinded treatment phase, exposure-adjusted subject incidences of osteonecrosis of the jaw (ONJ) were 49 (1.9 %) and 31 (1.2 %) in the denosumab and ZA groups, respectively. In total, 32 (6.9 %) and 25 (5.5 %) new cases of ONJ (not adjusted for exposure) were reported for patients continuing and switching to denosumab, respectively. The incidences of hypocalcemia were 4.3 and 3.1 %, in patients continuing and switching to denosumab, respectively. Conclusion: These results describe the safety profile of denosumab after long-term exposure, or after switching to denosumab from ZA. No new safety signals were identified. Hypocalcemia rates were similar in the blinded treatment and open-label phases. ONJ rates increased with increasing exposure to antiresorptives, consistent with previous reports.

Original languageEnglish (US)
Pages (from-to)447-455
Number of pages9
JournalSupportive Care in Cancer
Volume24
Issue number1
DOIs
StatePublished - Jan 1 2016

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zoledronic acid
Prostatic Neoplasms
Breast Neoplasms
Safety
Osteonecrosis
Therapeutics
Jaw
Hypocalcemia
Denosumab
Incidence
Neoplasm Metastasis
Bone and Bones

Keywords

  • Bone metastases
  • Breast cancer
  • Denosumab
  • Osteonecrosis of the jaw
  • Prostate cancer
  • Zoledronic acid

ASJC Scopus subject areas

  • Oncology

Cite this

Safety of long-term denosumab therapy : results from the open label extension phase of two phase 3 studies in patients with metastatic breast and prostate cancer. / Stopeck, Alison T; Fizazi, Karim; Body, Jean Jacques; Brown, Janet E.; Carducci, Michael; Diel, Ingo; Fujiwara, Yasuhiro; Martín, Miguel; Paterson, Alexander; Tonkin, Katia; Shore, Neal; Sieber, Paul; Kueppers, Frank; Karsh, Lawrence; Yardley, Denise; Wang, Huei; Maniar, Tapan; Arellano, Jorge; Braun, Ada.

In: Supportive Care in Cancer, Vol. 24, No. 1, 01.01.2016, p. 447-455.

Research output: Contribution to journalArticle

Stopeck, AT, Fizazi, K, Body, JJ, Brown, JE, Carducci, M, Diel, I, Fujiwara, Y, Martín, M, Paterson, A, Tonkin, K, Shore, N, Sieber, P, Kueppers, F, Karsh, L, Yardley, D, Wang, H, Maniar, T, Arellano, J & Braun, A 2016, 'Safety of long-term denosumab therapy: results from the open label extension phase of two phase 3 studies in patients with metastatic breast and prostate cancer', Supportive Care in Cancer, vol. 24, no. 1, pp. 447-455. https://doi.org/10.1007/s00520-015-2904-5
Stopeck, Alison T ; Fizazi, Karim ; Body, Jean Jacques ; Brown, Janet E. ; Carducci, Michael ; Diel, Ingo ; Fujiwara, Yasuhiro ; Martín, Miguel ; Paterson, Alexander ; Tonkin, Katia ; Shore, Neal ; Sieber, Paul ; Kueppers, Frank ; Karsh, Lawrence ; Yardley, Denise ; Wang, Huei ; Maniar, Tapan ; Arellano, Jorge ; Braun, Ada. / Safety of long-term denosumab therapy : results from the open label extension phase of two phase 3 studies in patients with metastatic breast and prostate cancer. In: Supportive Care in Cancer. 2016 ; Vol. 24, No. 1. pp. 447-455.
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abstract = "Purpose: Zoledronic acid (ZA) or denosumab treatment reduces skeletal-related events; however, the safety of prolonged therapy has not been adequately studied. Here, we describe safety results of extended denosumab therapy in patients with bone metastases from the open-label extension phase of two phase 3 trials. Methods: Patients with metastatic breast or prostate cancer received subcutaneous denosumab 120 mg Q4W or intravenous ZA 4 mg Q4W in a double-blinded fashion. Denosumab demonstrated superior efficacy in the blinded treatment phase; thus, patients were offered open-label denosumab for up to an additional 2 years. Results: Cumulative median (Q1, Q3) denosumab exposure was 19.1 (9.2, 32.2) months in the breast cancer trial (n = 1019) and 12.0 (5.6, 21.3) months in the prostate cancer trial (n = 942); 295 patients received denosumab for >3 years. No new safety signals were identified during the open-label phase, or among patients who switched from ZA to denosumab. During the blinded treatment phase, exposure-adjusted subject incidences of osteonecrosis of the jaw (ONJ) were 49 (1.9 {\%}) and 31 (1.2 {\%}) in the denosumab and ZA groups, respectively. In total, 32 (6.9 {\%}) and 25 (5.5 {\%}) new cases of ONJ (not adjusted for exposure) were reported for patients continuing and switching to denosumab, respectively. The incidences of hypocalcemia were 4.3 and 3.1 {\%}, in patients continuing and switching to denosumab, respectively. Conclusion: These results describe the safety profile of denosumab after long-term exposure, or after switching to denosumab from ZA. No new safety signals were identified. Hypocalcemia rates were similar in the blinded treatment and open-label phases. ONJ rates increased with increasing exposure to antiresorptives, consistent with previous reports.",
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T2 - results from the open label extension phase of two phase 3 studies in patients with metastatic breast and prostate cancer

AU - Stopeck, Alison T

AU - Fizazi, Karim

AU - Body, Jean Jacques

AU - Brown, Janet E.

AU - Carducci, Michael

AU - Diel, Ingo

AU - Fujiwara, Yasuhiro

AU - Martín, Miguel

AU - Paterson, Alexander

AU - Tonkin, Katia

AU - Shore, Neal

AU - Sieber, Paul

AU - Kueppers, Frank

AU - Karsh, Lawrence

AU - Yardley, Denise

AU - Wang, Huei

AU - Maniar, Tapan

AU - Arellano, Jorge

AU - Braun, Ada

PY - 2016/1/1

Y1 - 2016/1/1

N2 - Purpose: Zoledronic acid (ZA) or denosumab treatment reduces skeletal-related events; however, the safety of prolonged therapy has not been adequately studied. Here, we describe safety results of extended denosumab therapy in patients with bone metastases from the open-label extension phase of two phase 3 trials. Methods: Patients with metastatic breast or prostate cancer received subcutaneous denosumab 120 mg Q4W or intravenous ZA 4 mg Q4W in a double-blinded fashion. Denosumab demonstrated superior efficacy in the blinded treatment phase; thus, patients were offered open-label denosumab for up to an additional 2 years. Results: Cumulative median (Q1, Q3) denosumab exposure was 19.1 (9.2, 32.2) months in the breast cancer trial (n = 1019) and 12.0 (5.6, 21.3) months in the prostate cancer trial (n = 942); 295 patients received denosumab for >3 years. No new safety signals were identified during the open-label phase, or among patients who switched from ZA to denosumab. During the blinded treatment phase, exposure-adjusted subject incidences of osteonecrosis of the jaw (ONJ) were 49 (1.9 %) and 31 (1.2 %) in the denosumab and ZA groups, respectively. In total, 32 (6.9 %) and 25 (5.5 %) new cases of ONJ (not adjusted for exposure) were reported for patients continuing and switching to denosumab, respectively. The incidences of hypocalcemia were 4.3 and 3.1 %, in patients continuing and switching to denosumab, respectively. Conclusion: These results describe the safety profile of denosumab after long-term exposure, or after switching to denosumab from ZA. No new safety signals were identified. Hypocalcemia rates were similar in the blinded treatment and open-label phases. ONJ rates increased with increasing exposure to antiresorptives, consistent with previous reports.

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KW - Breast cancer

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KW - Zoledronic acid

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