New Bone-Building Drug Promising Against Prostate Cancer

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Although denosumab is an "important" drug and "clearly effective based on the two studies that have been published (the other was in postmenopausal women)," its place in prostate cancer therapy has yet to be established, said Dr. Sundeep Khosla, a professor of medicine in the Endocrine Research Unit at the Mayo Clinic, who wrote an accompanying editorial.

A number of other drugs now are being used to help prevent fractures in men treated for prostate cancer, Khosla said. "Given other drugs that perhaps have similar efficacy, just where this drug will fit is unclear," he noted.

The main contender against denosumab appears to be a relatively new member of the bone-building bisphosphonate family, zoledronic acid (Zometa), Khosla said. It, too, is given intravenously, with only one injection a year required, he said. But zoledronic acid must be given by a physician, while denosumab can potentially be self-administered, he noted.

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Cost can be an issue with these new drugs, Khosla said. A generic bisphosphonate can cost as little as $100 a year, while the wholesale price of zoledronic acid is $1,300 a year. It's not known yet what Amgen would charge for denosumab, Khosla said.

Whatever the price, "in certain subsets of patients it would be a good option," he said. Khosla agreed with Smith's estimate that one-third to one-half of all men getting hormone-blocking therapy could be in that subset.

Some concern about possible effects of denosumab on the immune system have been raised, Khosla noted, because the molecule it blocks plays a role in the immune response. A study of postmenopausal women noted some immunity-related problems, such as an increase in the incidence of eczema, he noted, but "I don't think there is any concern significant enough to warrant not approving the medication, although it warrants surveillance."

More information

Prostate cancer and its treatment are described by the U.S. National Cancer Institute.

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