TY - JOUR
T1 - Prognostic role of serum parathyroid hormone levels in advanced prostate cancer patients undergoing zoledronic acid administration
AU - Berruti, Alfredo
AU - Cook, Richard
AU - Saad, Fred
AU - Buttigliero, Consuelo
AU - Lipton, Allan
AU - Tampellini, Marco
AU - Lee, Ker Ai
AU - Coleman, Robert E.
AU - Smith, Matthew R.
PY - 2012
Y1 - 2012
N2 - Background. Secondary hyperparathyroidism is frequent in prostate cancer patients with bone metastases, and this condition is worsened by the administration of potent bisphosphonates. Serum parathyroid hormone (PTH) elevation can impair the efficacy of these drugs in terms of survival. Methods. The prognostic role of elevated serum PTH levels at baseline and after 3 months of zoledronic acid administration was assessed prospectively in 643 bone metastatic prostate cancer patients enrolled in a prospective randomized, placebo-controlled study. Results. On multivariate analysis, after adjusting for major prognostic factors and bone turnover markers, elevated baseline serum PTH level was negatively associated with overall survival (hazard ratio [HR], 1.448; 95% confidence interval [CI], 1.045-2.006; p <.03) in zoledronic acid-treated patients but not in placebo-treated patients. In patients with normal baseline PTH levels, there was a trend but insignificant association between zoledronic acid administration and a better survival outcome than with placebo (HR, 0.81; 95% CI, 0.65-1.01;p =.065), whereas a trend in the opposite direction was observed in patients with elevated PTH levels (HR, 1.45; 95% CI, 0.87-2.39; p =.151); interaction test, p =.040. Elevated serum PTH level after 3 months of zoledronic acid treatment was not significantly associated with survival outcome. Conclusions. Secondary hyperparathyroidism has a negative prognostic impact in metastatic prostate cancer patients undergoing zoledronic acid administration. Counteracting elevated PTH levels by adequate doses of vitamin D may improve the efficacy of this drug.
AB - Background. Secondary hyperparathyroidism is frequent in prostate cancer patients with bone metastases, and this condition is worsened by the administration of potent bisphosphonates. Serum parathyroid hormone (PTH) elevation can impair the efficacy of these drugs in terms of survival. Methods. The prognostic role of elevated serum PTH levels at baseline and after 3 months of zoledronic acid administration was assessed prospectively in 643 bone metastatic prostate cancer patients enrolled in a prospective randomized, placebo-controlled study. Results. On multivariate analysis, after adjusting for major prognostic factors and bone turnover markers, elevated baseline serum PTH level was negatively associated with overall survival (hazard ratio [HR], 1.448; 95% confidence interval [CI], 1.045-2.006; p <.03) in zoledronic acid-treated patients but not in placebo-treated patients. In patients with normal baseline PTH levels, there was a trend but insignificant association between zoledronic acid administration and a better survival outcome than with placebo (HR, 0.81; 95% CI, 0.65-1.01;p =.065), whereas a trend in the opposite direction was observed in patients with elevated PTH levels (HR, 1.45; 95% CI, 0.87-2.39; p =.151); interaction test, p =.040. Elevated serum PTH level after 3 months of zoledronic acid treatment was not significantly associated with survival outcome. Conclusions. Secondary hyperparathyroidism has a negative prognostic impact in metastatic prostate cancer patients undergoing zoledronic acid administration. Counteracting elevated PTH levels by adequate doses of vitamin D may improve the efficacy of this drug.
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U2 - 10.1634/theoncologist.2011-0448
DO - 10.1634/theoncologist.2011-0448
M3 - Article
C2 - 22523198
AN - SCOPUS:84861608587
SN - 1083-7159
VL - 17
SP - 645
EP - 652
JO - Oncologist
JF - Oncologist
IS - 5
ER -