American Society of Clinical Oncology Executive Summary of the Clinical Practice Guideline Update on the Role of Bone-Modifying Agents in Metastatic Breast Cancer

Abstract

Bone-modifying agent therapy is only recommended for patients with breast cancer with evidence of bone metastases; denosumab 120 mg subcutaneously every 4 weeks, intravenous pamidronate 90 mg over no less than 2 hours, or zoledronic acid 4 mg over no less than 15 minutes every 3 to 4 weeks is recommended. There is insufficient evidence to demonstrate greater efficacy of one bone-modifying agent over another. In patients with a calculated serum creatinine clearance of more than 60 mg/min, no change in dosage, infusion time, or interval of bisphosphonate administration is required. Serum creatinine should be monitored before each dose. All patients should receive a dental examination and appropriate preventive dentistry before bone-modifying agent therapy and maintain optimal oral health. Current standards of care for cancer bone pain management should be applied at the onset of pain, in concert with the initiation of bone-modifying agent therapy. The use of biochemical markers to monitor bone-modifying agent use is not recommended.

Medical Treatment of Breast Cancer Bone Metastasis: From Bisphosphonates to Targeted Drugs

“…Therefore ASCO guideline recommends continuing bone modifying agent until evidence of substantial decline in patient's performance status. We know that bone modifying agents also reduce time to first and subsequent SRE (Van Poznak et al, 2011). Therefore development of a SRE is not an indication to stop bone modifying agent.…”

“…All approved bisphosphonates and denosumab are capable of decreasing bone pain caused by breast cancer bone metastasis to some degree. Different pain assessment tools and treatment protocols were used in clinical trial therefore to decide which one is better is not possible (Van Poznak et al, 2011). Current standard care for cancer pain must be applied to all patients with bone pain.…”

Long-term safety of monthly zoledronic acid therapy beyond 1 year in patients with advanced cancer involving bone (LoTESS): A multicentre prospective phase 4 study

“…An important approach for those patients who have been diagnosed with, or developed bone disease as part of their underlying cancer, is to offer bisphosphonate therapy to alter bone metabolism and control bone remoulding and hence, prevent further episodes of bone disease progression (Lacy et al., 2006; Morgan et al., 2012; van Poznak et al., 2011). …”

“…However, patients in pivotal trials in advanced cancer settings were often not treated beyond 1 year (Rosen et al., 2003; Saad et al., 2004), and uncertainties remained over prolonged use of ZOL. Consequently, most treatment guidelines recommend the use of ZOL for at least 1 year with continuation at the physician's discretion (Hillner et al., 2003; Kyle et al., 2007; Lacy et al., 2006; van Poznak et al., 2011). In addition, increases in the incidence of osteonecrosis of the jaw (ONJ) and renal impairment were reported in patients receiving ZOL for time periods longer than 2 years (Bamias et al., 2005; Oh et al., 2007).…”

Impact of18F-Fluoride PET on Intended Management of Patients with Cancers Other Than Prostate Cancer: Results from the National Oncologic PET Registry

“…Osseous metastatic disease accounts for substantial morbidity, ranging from pain to debilitating complications such as pathologic fractures and spinal cord compression (3). In addition to local radiotherapy, bisphosphonates and denosumab have modest efficacy in reducing skeletal complications across cancer types, although these therapies have not to date been shown to prolong survival (4,5).…”