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

McGrath, Leah J.; Overman, Robert A.; Reams, Diane; Cetin, Karynsa; Liede, Alexander; Narod, Steven A.; Brookhart, M. Alan; Hernandez, Rohini K.

doi:10.2147/clep.s175063

Cited by 11 publications

(11 citation statements)

References 41 publications

(38 reference statements)

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“…The proportion of MBC patients not receiving a BMA has varied from 4% to 45% in routine practice in studies from the United States of America and Europe. [17][18][19][20][21] Unlike previous studies that have reported that elderly breast cancer patients were less likely to receive BMA, 17,22 we did not observe an age difference between patients who received BMA compared with those that did not. McGrath et al 17 reported in an American cohort that patients were less likely to receive a BMA if they had non-bone metastases.…”

Section: Discussioncontrasting

confidence: 94%

Uptake of bone‐modifying agents in patients with HER2+ metastatic breast cancer with bone metastases – prospective data from a multi‐site Australian registry

Wong

Boer

Dunn

et al. 2022

Internal Medicine Journal

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Background International practice guidelines recommend administration of bone‐modifying agents (BMA) in metastatic breast cancer (MBC) patients with bone metastases to reduce skeletal‐related events (SRE). Optimal delivery of BMA in routine clinical practice, including agent selection and prescribing intervals, remains unclear. Aim To describe real‐world practice of Australian breast oncologists. Methods Prospective data from February 2015 to July 2020 on BMA delivery to MBC patients with bone metastases was analysed from Treatment of Advanced Breast Cancer in the Human Epidermal Growth Factor Receptor 2 (HER2)‐Positive Australian Patient (TABITHA), a multi‐site Australian HER2+ MBC registry. Results Of 333 HER2+ MBC patients, 171 (51%) had bone metastases at diagnosis, with a mean age of 58.1 years (range, 32–87). One hundred and thirty (76%) patients received a BMA, with 90 (69%) receiving denosumab and 40 (31%) receiving a bisphosphonate. Patients who received a BMA were more likely to have received concurrent first‐line systemic anti‐HER2 therapy (95% vs 83%; P = 0.04), to present with bone‐only metastases at diagnosis (24% vs 7%; P = 0.02) and less likely to have visceral metastases (51% vs 71%; P = 0.03). Ten of 40 (25%) bisphosphonate patients and 45 of 90 (50%) denosumab patients received their BMA at the recommended 4‐weekly interval. Prescribing intervals varied over time. Adverse events reported were consistent with clinical trial data. Conclusion Three‐quarters of Australian HER2+ MBC patients with bone metastases receive a BMA, often at different schedules than guidelines recommend. Further studies, including all MBC subtypes, are warranted to better understand clinicians' prescribing rationale and potential consequences of current prescribing practice on SRE incidence.

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Section: Discussioncontrasting

confidence: 94%

Uptake of bone‐modifying agents in patients with HER2+ metastatic breast cancer with bone metastases – prospective data from a multi‐site Australian registry

Wong

Boer

Dunn

et al. 2022

Internal Medicine Journal

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“… 8 , 18 Cancer treatment guidelines recommend treatment with BTAs in patients at risk for SREs; however, real-world studies suggest that a large proportion of eligible patients do not receive BTAs. 19 , 20 In fact, more than half of BTA-treated patients may not initiate BTA therapy until after experiencing an initial SRE. 20 The reasons for low BTA usage are not well understood but may be related to supportive cancer care being delayed or overlooked.…”

Section: Introductionmentioning

confidence: 99%

Assessment of Bone Health Education in US Multiple Myeloma and Solid Tumor Patients at Risk for Skeletal-Related Events

Flora¹,

Carlson²,

Fuehrer³

et al. 2021

CMAR

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Purpose: Cancer patients with bone metastasis (BM) from solid tumors or multiple myeloma (MM) have an increased risk of painful skeletal-related events (SREs), which can decrease quality of life and increase mortality. Bone targeting agents (BTAs) can help delay or prevent SREs; however, a significant portion of eligible patients are not receiving BTA therapy. This study was conducted to understand patient awareness of cancer-related bone health and to identify opportunities to improve bone health education in cancer patients at risk of SREs. Methods: The online BonE heAlth eduCatiOn Needs assessment (BEACON) survey included questions about patient demographics, cancer diagnosis and treatments (including BTA usage), and extent and satisfaction with bone health education received. Direct-topatient outreach was used to recruit patients. Eligible patients were US adults with a diagnosis of self-reported MM or BM from a solid tumor (breast, lung, or prostate cancer) within the past three years. Results: Of 125 patients, 71% were diagnosed with solid tumors with BM and 29% with MM. At least one prior SRE was experienced by 57% of patients (38% radiation to bone, 32% bone fracture, 22% spinal cord compression, and 19% surgery to bone), and 74% were currently receiving BTA therapy. Awareness of cancer bone health, protection strategies, and screening tests was low to moderate; patients were least informed of the impact of lifestyle changes (38%) and specific cancer treatments (≤35%) on bone health. Sixty-two percent of patients were not completely satisfied with the bone health education received. Patients generally wanted more information (58%) and to receive information by more than one mode of communication. Conclusion:Notable gaps in bone health education were observed in cancer patients at risk for SREs indicating an important need for improved communication and education strategies to promote better health outcomes.

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“…It should be noted that some patients (maximum ~ 10%) had received prior antiresorptive therapy at baseline, and less than onequarter of patients across cancer types had one or more SRE prior to enrollment. Insights from other real-world studies also indicate wide variations in the proportion of patients initiating therapy and the timing of initiation [15,16,[21][22][23][24][25]. Various factors may influence the decision to delay BTAs, including a recent BM diagnosis (no time to initiate), perceived low risk of bone complications, patient refusal, patient frailty, and risk of osteonecrosis of the jaw [16,21,24].…”

Section: Discussionmentioning

confidence: 99%

“…Insights from other real-world studies also indicate wide variations in the proportion of patients initiating therapy and the timing of initiation [15,16,[21][22][23][24][25]. Various factors may influence the decision to delay BTAs, including a recent BM diagnosis (no time to initiate), perceived low risk of bone complications, patient refusal, patient frailty, and risk of osteonecrosis of the jaw [16,21,24]. Access and reimbursement, experience of the multidisciplinary team, and variations in recommendations for different cancer types may also influence the decision to delay treatment [16,24].…”

Section: Discussionmentioning

confidence: 99%

“…Various factors may influence the decision to delay BTAs, including a recent BM diagnosis (no time to initiate), perceived low risk of bone complications, patient refusal, patient frailty, and risk of osteonecrosis of the jaw [16,21,24]. Access and reimbursement, experience of the multidisciplinary team, and variations in recommendations for different cancer types may also influence the decision to delay treatment [16,24]. The impact of delayed treatment with denosumab is not well studied.…”

Section: Discussionmentioning

confidence: 99%

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Medication adherence with denosumab in patients with bone metastases from solid tumors treated in routine clinical settings: a retrospective study

Diel

Greil

Janssen

et al. 2022

Support Care Cancer

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Purpose To describe (non)adherence with denosumab among patients with solid tumors and bone metastases. Methods This retrospective, observational study pooled data from two completed prospective, multicenter cohort studies (X-TREME; Study 240) in adult patients with bone metastases from primary breast, prostate, lung, kidney, or other solid cancer types and administered denosumab 120 mg in routine clinical practice in Germany and Central and Eastern Europe. The studies were conducted between May 2012 and May 2017; pooled analysis was completed in August 2021. Medication adherence was described according to a three-component consensus taxonomy: initiation (first-ever administration ≤ 90 days from bone metastasis diagnosis), implementation (actual vs prescribed dosing; optimal implementation = regular/consistent dosing), and persistence (≤ 60-day gap between administrations at 3, 6, 9, and 12 months). Descriptive analyses were conducted for each cancer type. Results The analysis included 1748 patients with solid tumors and bone metastases. Adherence with denosumab was generally high across the initiation, implementation, and persistence phases. Most patients experienced timely initiation (from 64.4% [kidney cancer] to 81.2% [breast cancer]) and optimal implementation (from 62.4% [lung cancer] to 72.5% [breast cancer]). The proportion of patients who were persistent with treatment at 6 months ranged from 41.4% (lung cancer) to 77.8% (prostate cancer). Conclusions This study revealed variations by cancer type in the initiation, implementation, and persistence of denosumab in patients with solid tumors and bone metastases in routine clinical practice. Further cancer-specific studies are warranted to examine the determinants of (non)adherence with denosumab, and potential ways to improve medication adherence.

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

Cited by 11 publications

References 41 publications

Uptake of bone‐modifying agents in patients with HER2+ metastatic breast cancer with bone metastases – prospective data from a multi‐site Australian registry

Uptake of bone‐modifying agents in patients with HER2+ metastatic breast cancer with bone metastases – prospective data from a multi‐site Australian registry

Assessment of Bone Health Education in US Multiple Myeloma and Solid Tumor Patients at Risk for Skeletal-Related Events

Medication adherence with denosumab in patients with bone metastases from solid tumors treated in routine clinical settings: a retrospective study

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