News in brief: Synergy with bone resorption inhibitors + abiraterone in mCAPC; ICIs benefit some advanced MPeM patients; Australia wins bronze in global health services ranking

10 Aug 2021

Synergy with bone resorption inhibitors and abiraterone in mCAPC

The addition of bone resorption inhibitors (BRIs) to abiraterone acetate with prednisone as first line therapy for metastatic castration-resistant prostate cancer (mCRPC) with bone metastases improves overall survival.

According to a retrospective cohort study of 745 men published in JAMA Network Open, BRIs improved OS (31.8 v 23.0 months; HR 0.65; p <0.001) and particularly in the subgroup of men with high-volume vs low-volume disease (33.6 v 19.7 months; HR 0.51; p < 0.001).

“This survival association is consistent with the increasing body of evidence suggesting that treatment with concurrent BRIs may provide an additive benefit to life-prolonging agents approved for the treatment of mCRPC,” the study said.

The type of BRI (denosumab vs zoledronic acid) received was not associated with OS.

An Invited Commentary in the journal said the study highlighted the importance of bone-targeted therapy in current practice for men with mCRPC and bone metastases.

“Moreover, this study supports the hypothesis that BRIs may be particularly important for men with high volume metastases, a hypothesis that warrants prospective testing in future studies.”

ICIs may benefit some advanced MPeM patients

Immune checkpoint inhibitors (ICIs) could benefit some malignant peritoneal mesothelioma (MPeM) patients, US research suggests.

Published in JAMA Network Open, the study reviewed ICI response rates in 29 MPeM patients at the MD Anderson Cancer Centre who had previously received platinum-pemetrexed therapy and/or surgery, could not participate in clinical trials and otherwise had no or limited treatment options.

Of 26 evaluable patients, five had an objective response rate (ORR) and one maintained their response at data cut off, the authors wrote.

No significant difference in ORR was seen in the nivolumab plus ipilimumab group versus the single agent ICI (atezolizumab, nivolumab or pembrolizumab) group, they added.

The median progression free and overall survival periods were 5.5 months (95% CI: 3.4–9.2 months) and 19.1 months (95% CI: 7.4–43.2 months) respectively.

Therapy was well tolerated, with only one patient discontinuing treatment due to toxic effects, the authors reported.

“Promising results” in malignant pleural mesothelioma (MPM) have led the MD Anderson Center to use ICIs off-label in certain advanced MPeM patients, however, caution should be exercised when extrapolating data from MPM to MPeM as they appear to be molecularly and immunologically different diseases, they noted.

There is currently no standard or approved treatment beyond first-line platinum-pemetrexed therapy, they wrote.

Larger trials are needed to define biomarkers of ICI response or resistance and new combinatorial strategies to improve responses and outcomes for MPeM patients, they concluded.

Australia wins bronze in global health services ranking

The COVID-19 ravaged UK’s National Health Service has slipped from first place to fourth in a ranking of global health services in 11 high-income countries allowing Australia to step onto the podium in third place overall.

US think tank the Commonwealth Fund’s assessment of healthcare system performance looked at 71 measures across five areas – access to care, care process, administrative efficiency, equity, and healthcare outcomes.

It found the top-performing countries overall to be Norway, the Netherlands, and Australia, followed by the UK.

Australia was first in the domains of equity and health care outcomes, second in administrative efficiency but performed less well in care process and access to care.

The UK’s drop in rankings has been attributed to the impact of the pandemic on the overall health service.

The United States ranked last overall and in all but one domain, despite spending far more of its gross domestic product on health care than other countries.

New Zealand topped the domain of care process which measures activities such as preventive care, safe care, coordinated care, and engagement and patient preferences.

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