Zoledronic Acid Outcomes Reported in Ivorian Prostate Cancer Cohort

Men with metastatic castration-resistant prostate cancer and bone metastases treated with zoledronic acid at Treichville University Hospital in Abidjan experienced new skeletal complications in about one case in five during therapy, according to a retrospective single-center cohort study conducted in Côte d'Ivoire. Among 144 patients treated between January 2019 and December 2021, 30 patients, or 20.8 percent, experienced at least one new on-treatment skeletal-related event, while the remaining 114 patients, 79.2 percent of the cohort, did not. Median skeletal event-free survival, the study's primary endpoint, was not reached during follow-up, and the estimated 12-month skeletal event-free survival stood at 79.2 percent.

The study, led by researchers affiliated with Félix Houphouët-Boigny University and the university hospitals of Treichville and Bouaké, addresses a gap in the oncology literature. Zoledronic acid is used to prevent skeletal complications in patients whose prostate cancer has progressed despite castration, but real-world data from sub-Saharan Africa, where disease presentation and health-system resources differ substantially from high-income countries, have remained scarce. The median age of the 144 patients was 67 years, with ages ranging from 42 to 91, and 133 patients, or 92.4 percent, were older than 50.

Before zoledronic acid was initiated, 59 patients, or 41.0 percent, had already experienced at least one skeletal-related event. Among the 30 patients who did experience a new skeletal-related event while on zoledronic acid, the median time from the first infusion to the first event was 9 months, with a range of 5 to 11 months. The study defined skeletal event-free survival as the time elapsed from the first zoledronic acid administration to the first on-treatment skeletal-related event, with patients who remained free of such events censored at their last available follow-up.

Because the median had not been reached, the investigators relied on the 12-month estimate of 79.2 percent to characterize the cohort's trajectory. The most frequently documented adverse events were bone pain, reported in 18.8 percent of patients, constipation in 18.1 percent, and nausea in 9.7 percent. Quality-of-life data added a further dimension to the results.

The Functional Assessment of Cancer Therapy-General questionnaire, known as FACT-G, was available at both baseline and 12 months for 129 patients, or 89.6 percent of the cohort. Across all four FACT-G domains, as well as in the total score, mean values were numerically lower at 12 months than at baseline. The study's design imposes limits on interpretation.

As a retrospective, single-center cohort, it cannot establish that zoledronic acid caused the observed outcomes, since patients were not randomized and no comparator group was available. The findings also highlight the burden of pretreatment skeletal morbidity, with more than four in ten patients having already experienced a skeletal event before therapy began. For patients and clinicians in similar settings, the study offers a grounded picture of zoledronic acid use outside trial conditions: 79.2 percent of patients avoided a new skeletal-related event during the first year of treatment, the most commonly documented adverse events were bone pain, constipation and nausea, and FACT-G scores were numerically lower at 12 months than at baseline.

The authors position their results as real-world evidence from a resource-limited setting, a phrase that captures both the contribution and the caution of the work. The final, formatted version of the article is slated for publication in Frontiers in Oncology in the genitourinary oncology section.

Subject of Research: Real-world outcomes and safety of zoledronic acid in metastatic castration-resistant prostate cancer with bone metastases in Côte d'Ivoire

Article Title: Clinical outcomes and safety of zoledronic acid in castration-resistant metastatic prostate cancer with bone metastases: real-world data from Côte d’Ivoire

Article References: Odo, B. A., Kouassi, K. K. Y., Toure, P. G. L., Gnabro, G. A. P., Touré, Y. L., Madiou, M. K. A., Mbarga Amougou, F., Mebiala, N. M. P., Sessegnon, F. A., Nogbou, A. M. B. Y., Agrigna, H., Sako, K., Toure, M., & Adoubi, I. (2026). Clinical outcomes and safety of zoledronic acid in castration-resistant metastatic prostate cancer with bone metastases: real-world data from Côte d’Ivoire. Frontiers in Oncology, 16, Article 1847737. https://doi.org/10.3389/fonc.2026.1847737

Image Credits: AI Generated

DOI: 10.3389/fonc.2026.1847737

Keywords: zoledronic acid, prostate cancer, bone metastases, skeletal-related events, mCRPC, Côte d'Ivoire, real-world data, quality of life, resource-limited setting, oncology, cohort study, Clinical