Dexamethasone for the Prophylaxis of Radiation-induced Pain Flare after Palliative Radiotherapy for Symptomatic Bone Metastases: a Phase II Study

Hird, Amanda; Zhang, L.; Holt, Tanya; Fairchild, Alysa; DeAngelis, Carlo; Loblaw, Andrew; Wong, Rebecca; Barnes, Elizabeth; Tsao, May; Danjoux, Cyril; Chow, Edward

doi:10.1016/j.clon.2008.12.010

Cited by 71 publications

(44 citation statements)

References 17 publications

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“…In clinical trials pain flares occurred in 14e44% of patients [37,38]. In a non-randomized phase II trial dexamethasone (at 8 mg, administered just before radiation therapy, and for three consecutive days after treatment) has been shown to be effective in the prophylaxis of radiation induced-pain flares [39]. Hematologically, localized field radiotherapy to the bones is generally considered as a safe treatment; still, if several metastatic sites have to be irradiated simultaneously, radiotherapy would have a profound effect on bone marrow function that may compromise the administration of subsequent chemotherapy.…”

Section: Toxic Effects Of Radiotherapymentioning

confidence: 99%

Bone health in breast cancer patients: A comprehensive statement by CECOG/SAKK Intergroup

et al. 2014

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Bone is the most common site of distant metastases in breast cancer that can cause severe and debilitating skeletal related events (SRE) including hypercalcemia of malignancy, pathologic fracture, spinal cord compression and the need for palliative radiation therapy or surgery to the bone. SRE are associated with substantial pain and morbidity leading to frequent hospitalization, impaired quality of life and poor prognosis. The past 25 years of research on the pathophysiology of bone metastases led to the development of highly effective treatment options to delay or prevent osseous metastases and SRE. Management of bone metastases has become an integral part of cancer treatment requiring expertise of multidisciplinary teams of medical and radiation oncologists, surgeons and radiologists in order to find an optimal treatment for each individual patient. A group of international breast cancer experts attended a Skeletal Care Academy Meeting in November 2012 in Istanbul and discussed current preventive measures and treatment options of SRE, which are summarized in this evidence-based consensus for qualified decision- making in clinical practice.

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Section: Toxic Effects Of Radiotherapymentioning

confidence: 99%

Bone health in breast cancer patients: A comprehensive statement by CECOG/SAKK Intergroup

et al. 2014

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“…For that purpose, besides various local and systemic therapies including radiation, chemotherapeutics and surgical approaches [7,8], the use of bone-targeted osteoclast inhibitors has led to significant advances [9,10]. Osteoclast inhibitors comprise 2 classes of agents, the bisphosphonates and the fully human monoclonal antibody denosumab.…”

Section: Introductionmentioning

confidence: 99%

Side Effects of Bone-Targeted Therapies in Advanced Breast Cancer

Domschke

Schuetz²

2014

Breast Care

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In up to 75% of cases, advanced breast cancer patients eventually develop bone metastases with often debilitating skeletal-related events (SREs). Osteoclast inhibitors are commonly used as therapeutic mainstay with clinical studies showing superiority of denosumab over bisphosphonates (e.g., zoledronate) for the prevention of SREs. The present review discusses the adverse event profile of these agents, and addresses the prevention and management of untoward side effects. Adverse events associated with osteoclast inhibitors comprise osteonecrosis of the jaw and hypocalcemia. Hypocalcemia is more common with denosumab, particularly in severe renal dysfunction. During therapy, the appropriate prevention of these adverse events includes close attention to dental health, avoidance of invasive dental procedures, supplementation with calcium and vitamin D unless patients are hypercalcemic, and regular monitoring of relevant serum values. Relating to the risk of nephrotoxicity, bisphosphonates but not denosumab have been incriminated. Therefore, serum creatinine levels should be checked prior to each dose of zoledronate, and in severe renal dysfunction (creatinine clearance < 30 ml/min) zoledronate is contraindicated anyway. Acute-phase reactions are particularly linked to bisphosphonates. Consequently, if these adverse events predominate, switching to denosumab is recommended.

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“…Reported rates of bone flare range from 2e44%. 6 Fractures should be internally fixed or where there is a significant risk of pathological fracture secondary to bone metastasis, prophylactic internal fixation is recommended prior to radiotherapy. This is considered standard care in the UK despite little evidence to support this practice.…”

Section: Palliative Radiotherapy For Bone Metastasesmentioning

confidence: 99%

(v) The non-surgical management of musculoskeletal malignancy

Esler

2009

Orthopaedics and Trauma

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Dexamethasone for the Prophylaxis of Radiation-induced Pain Flare after Palliative Radiotherapy for Symptomatic Bone Metastases: a Phase II Study

Cited by 71 publications

References 17 publications

Bone health in breast cancer patients: A comprehensive statement by CECOG/SAKK Intergroup

Bone health in breast cancer patients: A comprehensive statement by CECOG/SAKK Intergroup

Side Effects of Bone-Targeted Therapies in Advanced Breast Cancer

(v) The non-surgical management of musculoskeletal malignancy

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