Treatment and pattern of bone metastases in 1094 patients with advanced breast cancer – Results from the prospective German Tumour Registry Breast Cancer cohort study

Schröder, J; Fietz, Thomas; Köhler, A; Petersen, Volker; Tesch, Hans; Spring, Lisa; Fleitz, A.; Jänicke, Martina; Marschner, Norbert

doi:10.1016/j.ejca.2017.03.031

Cited by 42 publications

(28 citation statements)

References 29 publications

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“…The median OS was 30 and 68.2 months from initial diagnosis in the SEER cohort and FUSCC cohort, respectively, which is similar with the survival reported by previous authors 20, 29, 30, 33. We assume that the longer survival in the FUSCC cohort was because the patients in this cohort were much younger and had less extraosseous metastatic sites.…”

Section: Discussionsupporting

confidence: 89%

“…We also validated the results of survival analysis in another independent cohort from FUSCC. Some studies have evaluated the epidemiology and prognosis of breast cancer patients with bone metastases at the population level, but most of the patients in these studies presented bone metastases after a diagnosis of early‐stage breast cancer 2, 20, 29, 30, 31, 32, 33. However, limited data have been reported in the specific group of patients with bone metastases upon their initial diagnosis of breast cancer 34.…”

Section: Discussionmentioning

confidence: 99%

“…A recent study showed that compared with patients with visceral metastases with or without bone metastases, patients with bone‐only metastases at start of first‐line therapy had an improved median OS (54 months vs 28 months) 29. Other studies also found that the median survival of patients with bone‐only metastases was approximately twofold to threefold that of patients with additional visceral metastases 30, 41, 42, 43.…”

Section: Discussionmentioning

confidence: 99%

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Incidence proportions and prognosis of breast cancer patients with bone metastases at initial diagnosis

Gong

Zhang

et al. 2018

Cancer Medicine

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IntroductionPopulation‐based data on the incidence and prognosis of bone metastases at diagnosis of breast cancer are currently limited. Hence, we conducted this study to analyze the incidence proportions and prognostic factors of patients with breast cancer and bone metastases at the time of cancer diagnosis.Materials and methodsPatients with primary invasive breast cancer and bone metastases at initial diagnosis between 2010 and 2014 were identified using the Surveillance, Epidemiology, and End Results (SEER) dataset and Fudan University Shanghai Cancer Center (FUSCC) cohort. Multivariable logistic regression was performed to identify predictors of the presence of bone metastases at diagnosis. Univariate and multivariate analyses were performed to determine the effects of each variable on survival.ResultsOf 229, 195 patients from SEER database included in the analysis, 8295 patients had bone metastases at initial diagnosis, reflecting 3.6% of the entire study population, and 65.1% of the subset with metastatic disease to any distant site. Patients with hormone receptor (HR)‐positive human epidermal growth factor receptor 2 (HER2)‐negative represented the highest incidence proportions among patients with metastatic disease (73.9%). Among entire cohort, multivariable logistic regression identified eight factors as predictors of the presence of bone metastases at diagnosis. Median OS for the patients with bone metastases in SEER and FUSCC cohorts was 30.0 and 68.2 months, respectively. Patients with HR‐positive HER2‐positive subtype had the longest median OS, and patients with triple‐negative subtype showed the shortest median OS. Multivariable Cox model in SEER cohort confirmed age, histology, grade, tumor subtype, extraosseous metastatic sites, history of primary surgery, insurance status, marital status, and income as independent prognostic factors for both OS and BCSS.ConclusionsThe findings of this study provide population‐based estimates of the incidence and prognosis for patients with bone metastases at initial diagnosis of breast cancer.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Incidence proportions and prognosis of breast cancer patients with bone metastases at initial diagnosis

Gong

Zhang

et al. 2018

Cancer Medicine

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“…However, a similar distribution between types of drugs was seen; zoledronic acid and denosumab were used almost equally. 27 Finally, a study conducted in men with prostate cancer and bone metastasis in routine care in the US showed that BMAs were used at slightly higher rates in this population (77% at 1 year), although incidence of treatment interruption (54% at 1 year) and reinitiation (81% at 1 year) were similar. 28 …”

Section: Discussionmentioning

confidence: 95%

Use of bone-modifying agents among breast cancer patients with bone metastasis: evidence from oncology practices in the US

McGrath¹,

Overman²,

Reams³

et al. 2018

CLEP

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PurposeBone-modifying agents (BMAs) are recommended for women with bone metastasis from breast cancer to prevent skeletal-related events. We examined the usage patterns and identified the factors associated with the use of BMAs (denosumab and intravenous bisphosphonates) among women in the US.Patients and methodsElectronic health records from oncology clinics were used to identify women diagnosed with bone metastasis from breast cancer between 2013 and 2014. Patients were excluded if they had recently used a BMA or had concurrent cancer at an additional primary site. The incidence of BMA initiation, interruption, and reinitiation were estimated using competing risk regression models. A generalized linear model was used to estimate risk factors for treatment initiation and interruption.ResultsThere were 589 women diagnosed with bone metastasis from breast cancer. By 1 year, 68% of these patients (95% CI: 64%, 71%) had initiated treatment with a BMA. Denosumab and zoledronic acid were the most commonly used agents, whereas pamidronate was used infrequently. Young women were more likely to initiate a BMA than older women (adjusted risk difference: 6.4 [95% CI: 1.5, 10.9]). Of the 412 patients who initiated a BMA, 46% (95% CI: 41%, 51%) experienced an interruption within 1 year. Seventy-four percent (95% CI: 68%, 79%) of patients who interrupted their treatment had reinitiated therapy within 1 year of interruption.ConclusionThe majority of women diagnosed with bone metastasis from breast cancer initiate a BMA within 1 year of diagnosis, but a large proportion, particularly among the elderly, do not use these therapies.

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“…The use of bisphosphonates and denosumab in clinical practice has been evaluated in several real-world data sets. Data from a German treatment registry showed that most patients (89%) with bone metastases from breast cancer receive treatment in line with guidelines, with bisphosphonates (primarily ZA) or denosumab started a median of 3 weeks after diagnosis of bone metastases [140]. Notably, data from the Adelphi Prostate Cancer and Breast Cancer Disease Specific Programmes showed that patients with breast cancer are more likely to receive bisphosphonate or denosumab treatment than those with prostate cancer [141].…”

Section: Treatment Guidelines and Real-world Treatment Patternsmentioning

confidence: 99%

Management of bone health in solid tumours: From bisphosphonates to a monoclonal antibody

Moos

Costa

Gonzalez-Suarez

et al. 2019

Cancer Treatment Reviews

105

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Patients with solid tumours are at risk of impaired bone health from metastases and cancer therapy-induced bone loss (CTIBL). We review medical management of bone health in patients with solid tumours over the past 30 years, from first-generation bisphosphonates to the receptor activator of nuclear factor κB ligand (RANKL)targeted monoclonal antibody, denosumab. In the 1980s, first-generation bisphosphonates were shown to reduce the incidence of skeletal-related events (SREs) in patients with breast cancer. Subsequently, more potent secondand third-generation bisphosphonates were developed, particularly zoledronic acid (ZA). Head-to-head studies showed that ZA was significantly more effective than pamidronate for reducing SREs in patients with breast and castrate-resistant prostate cancer (CRPC), becoming the standard of care for more than a decade. The RANKL inhibitor denosumab was licensed in 2010, and head-to-head studies and integrated analyses confirmed its superiority to ZA for preventing SREs, particularly in breast cancer and CRPC. Bisphosphonates and denosumab have also been investigated for prevention of CTIBL in patients receiving hormonal therapy for breast and prostate cancer, and denosumab is licensed in this indication. Despite advances in management of bone health, several issues remain, notably the optimal time to initiate therapy, duration of therapy, and dosing frequency, and how to avoid toxicity, particularly with long-term treatment. In summary, introduction of ZA and denosumab has protected patients with bone metastasis from serious bone complications and improved their quality of life. Ongoing research will hopefully guide the optimal use of these agents to help maintain bone health in patients with solid tumours.

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Treatment and pattern of bone metastases in 1094 patients with advanced breast cancer – Results from the prospective German Tumour Registry Breast Cancer cohort study

Cited by 42 publications

References 29 publications

Incidence proportions and prognosis of breast cancer patients with bone metastases at initial diagnosis

Incidence proportions and prognosis of breast cancer patients with bone metastases at initial diagnosis

Use of bone-modifying agents among breast cancer patients with bone metastasis: evidence from oncology practices in the US

Management of bone health in solid tumours: From bisphosphonates to a monoclonal antibody

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