Yesterday we learned that ADT+Zometa+Celebrex significantly increased survival, especially in men with mets. This was especially welcome news because neither ADT+Zometa nor ADT+Celebrex alone had any effect - it took all three. It's also good news because both Zometa and Celebrex are available now and don't require FDA approval.The study will be presented at the Genitourinary conference tomorrow. Here's the abstract of the study:
Celecoxib with or without zoledronic acid for hormone-naïve prostate cancer: Survival results from STAMPEDEThe STAMPEDE study was among men just starting on hormone therapy for high risk or metastatic PC, but adding Zometa and Celebrex may be of benefit even later on. Many of you are taking Zometa (and Xgeva - which probably works as well if not better) anyway, and adding Celebrex - an anti-inflammatory - is a relatively cheap and innocuous addition (unless you have a heart condition that precludes its use). It may be that aspirin works as well as Celebrex in this combination, if for some reason you can't take Celebrex, but that is not yet proven.
Regular aspirin use and the risk of lethal prostate cancer in the Physicians' Health Study.The biochemical basis for testing these substances in the STAMPEDE trial was that the bone microenvironment might be rendered less conducive to the growth of metastases. We’ve seen the association with progression in many studies with inflammation, and it seems to be both cause and effect. Some studies showed that ADT makes the bone microenvironment more hospitable to metastasis development (an effect vastly overpowered by its blocking of androgen-receptor mediated growth), but Zometa or Xgeva may prevent that effect if used at the start of ADT. There have been conflicting findings.
In the TROG 03.04 RADAR study they found that Zometa delayed progression only in men with Gleason scores of 8 to 10. I suspect that there is a certain phenotype that is more susceptible to the combined treatment.
- Allen