Jefferson Investigates: June 2026

The real-world fracture risk in men who are treated for advanced prostate cancer is much higher than what has been reported in randomized controlled trials, according to a recent study from Thomas Jefferson University researchers. The findings were published in the Journal of the National Cancer Institute.

Many men who take androgen receptor pathway inhibitors (ARPI) for advanced prostate cancer have osteoporosis or a history of fractures, which increases future fracture risk. But men with these preexisting conditions are typically excluded from randomized controlled trials, so the data doesn’t accurately depict real-world patient experiences.

Jefferson researchers used Surveillance, Epidemiology, and End Results (SEER)-Medicare registries to identify 10,463 men with advanced prostate cancer treated with ARPI (abiraterone acetate with prednisone or enzalutamide) between 2013 and 2020. They found that men without a fracture history who took ARPI for advanced prostate cancer had a 28% to 30% risk of fracture over three years. Among men with a fracture history before ARPI, three-year fracture risk exceeded 50%. Meta-analysis from randomized controlled trials showed a much lower fracture risk, 2% to 11%, for men who took ARPI.

“If you’re a patient, you may think, a 2% fracture risk is not too bad if you can control the cancer,” says Grace Lu-Yao, PhD, MPH, the study’s first author. “But a 50% fracture risk may change your mind about pursuing that treatment.”

The study revealed the fracture risk among men with prior fracture risk remained high (above 44%) despite bone health agents.

“This suggests we have to identify high-risk patients much earlier, even before they need ARPI,” says Dr. Lu-Yao.

Because more prostate cancer patients are starting ARPI at an earlier stage in their disease, fracture prevention becomes even more important.

“ARPI were initially approved for patients with late-stage prostate cancer, but now they are used by patients with more than 10 years of life expectancy,” says Dr. Lu-Yao, a Sidney Kimmel Medical College faculty member. “You will want to consider the risk of fracture if you still have a long time to live.”

The study findings could help patients and clinicians to make more-informed shared decisions about their cancer therapy. Postdoctoral researchers Amy Shaver, PhD, PharmD, MPH, and junior faculty Nikita Nikita, MD, MPH, were involved in the study.

By Lisa Fields

Social media can be useful for microlearning, an educational approach where information is presented in short, accessible formats, leading to high knowledge retention. In medical education, social media could also supplement learning by teaching about topics that are underrepresented in the official curriculum to reduce stigma, such as addiction or disability medicine.

However, social media remains underutilized in medical education. Hoping to change this, Gregory Jaffe, MD, family medicine professor at Sidney Kimmel Medical College at Thomas Jefferson University, conducted a cross-sectional survey to evaluate students’ social media use and attitudes toward social media in medical education. Participants came from medical and nursing schools at two Philadelphia institutions.

“One thing that made this project unique is that it was very learner-centered,” says Sarah Lawson, a Sidney Kimmel Medical College student who was involved with the study. “As a medical student, I felt like I got to bring my own learning experiences into the project to help design our survey questions.”

Results showed that surveyed students were lower-than-average consumers of social media, using most platforms for less than an hour per week. Even so, the majority also reported that they thought social media could be valuable for medical education. About 57% of students surveyed said they would use an evidence-based social media page for their learning if this was available.

While the study had a small sample size and further research on the topic is needed, the findings indicate that social media has potential for stigma reduction and education on topics left out of the mainstream curriculum. From here, Dr. Jaffe says, “We can start exploring social media as a tool and creating evidence-based accounts that people can trust, because there's a lot of misinformation and untrustworthy stuff that's out there.”

He adds, “[Students] are already being influenced … Medical educators can either participate with evidence-based stigma-reducing educational content, or they can just passively allow folks to absorb the content that they're seeing online without any say in the matter.”

By Zoe Cunniffe

Some 80,000 Americans will be diagnosed with kidney cancer this year, and 15% of those people will learn their cancer is too advanced for surgery.

New combination therapies developed in the last decade have revolutionized treatment and markedly improved survival, says Kevin Kayvan Zarrabi, MD, a medical oncologist at Thomas Jefferson University. Indeed, thanks to evidence from clinical trials, the therapies are now considered first-line treatment for advanced renal cell carcinoma. “The question that remains is the tolerability of the combination therapies in real-world settings,” he says.

In a new paper, Dr. Zarrabi and his colleagues sought to learn how well the combination therapy works in community settings, outside of the highly-controlled conditions of clinical trials. The study surveyed community oncologists — some 80% of cancer patients seek treatment outside academic medical centers — to learn how they manage the combination therapy and its adverse effects.

“After drug approvals, studies like this are crucial,” Dr Zarrabi says. “Efficacy in the real world is nearly always lower than what’s determined in a clinical study.”

The therapy itself combines two cancer-fighting drugs: axitinib and pembrolizumab. Both treatments can cause significant side effects, including blood clots, bleeding risk and hypertension; loss of appetite, weight loss and fatigue; and developing rashes on hands and feet.

The researchers were particularly interested in understanding physicians’ decision-making when their patients experience serious side effects. Short of quitting a treatment drug altogether, clinical guidelines make recommendations for reducing the dose or interrupting treatment.

The study’s results were encouraging. Patients do remarkably well on the combination therapy and relatively few patients stopped one or the other treatment completely because of adverse events. Doctors, who reported prioritizing survival rates, were able to maintain treatment by reducing or interrupting treatments to manage side effects. Reducing dose can reduce the toxicity of a treatment, while extending the duration of its benefits — even at a lower level.

Meanwhile kidney cancer research continues to see advances, with new drug targets identified and new compounds in development. Dr. Zarrabi says that real-world studies like this are becoming more common. The data may offer a more accurate picture of the risks and benefits of a therapy than the initial clinical trial data. That’s germane when considering a medical course of action, he says, adding: “It’s vitally important in how doctors speak to their patients and for shared decision-making.”

By Jill Adams