A phase III multicenter, randomized, controlled study of combined androgen blockade with versus without zoledronic acid in prostate cancer patients with metastatic bone disease: results of the ZAPCA trial.

Abstract

To examine the antitumor activity of zoledronic acid (ZA) combined with androgen deprivation therapy (ADT) for men with treatment-naive prostate cancer and bone metastasis. We enrolled 227 men with treatment-naive prostate cancer and bone metastasis. Participants were randomly assigned (1:1 ratio) to receive combined androgen blockade alone (CAB group) or ZA with combined androgen blockade (CZ group). Time to treatment failure (TTTF), time to the first skeletal-related event (TTfSRE), and overall survival (OS) rates were estimated using the Kaplan-Meier method. Hazard ratios (HRs) were calculated using the Cox proportional hazards model. Median follow-up duration was 41.5months. Median TTTFs were 12.4 and 9.7months for the CZ and CAB groups, respectively (HR 0.75; 95% CI 0.57-1.00; p=0.051). For men with baseline prostate-specific antigen levels <200ng/mL, median TTTFs were 23.7 and 9.8months for the CZ and CAB groups, respectively (HR 0.58; 95% CI 0.35-0.93; p=0.023). Median TTfSREs were 64.7 and 45.9months for the CZ and CAB groups, respectively (HR 0.58; 95% CI 0.38-0.88; p=0.009). OS was similar between the groups. This study failed to demonstrate that combined use of ZA and ADT significantly prolonged TTTF in men with treatment-naive prostate cancer and bone metastasis. However, it generates a new hypothesis that the combined therapy could delay the development of castration resistance in a subgroup of patients with low baseline prostate-specific antigen values <200ng/mL. The treatment also significantly prolonged TTfSRE but did not affect OS.