Role of Bone-Modifying Agents in Metastatic Breast Cancer: An American Society of Clinical Oncology–Cancer Care Ontario Focused Guideline Update

Abstract

Purpose To update, in collaboration with Cancer Care Ontario (CCO), key recommendations of the American Society of Clinical Oncology (ASCO) guideline on the role of bone-modifying agents (BMAs) in metastatic breast cancer. This focused update addressed the new data on intervals between dosing and the role of BMAs in control of bone pain. Methods A joint ASCO-CCO Update Committee conducted targeted systematic literature reviews to identify relevant studies. Results The Update Committee reviewed three phase III noninferiority trials of dosing intervals, one systematic review and meta-analysis of studies of de-escalation of BMAs, and two randomized trials of BMAs in control of pain secondary to bone metastases. Recommendations Patients with breast cancer who have evidence of bone metastases should be treated with BMAs. Options include denosumab, 120 mg subcutaneously, every 4 weeks; pamidronate, 90 mg intravenously, every 3 to 4 weeks; or zoledronic acid, 4 mg intravenously every 12 weeks or every 3 to 4 weeks. The analgesic effects of BMAs are modest, and they should not be used alone for bone pain. The Update Committee recommends that the current standard of care for supportive care and pain management-analgesia, adjunct therapies, radiotherapy, surgery, systemic anticancer therapy, and referral to supportive care and pain management-be applied. Evidence is insufficient to support the use of one BMA over another. Additional information is available at www.asco.org/breast-cancer-guidelines and www.asco.org/guidelineswiki .

Prognostic Factors in Patients with Metastatic Breast Cancer with Bone-Only Metastases

“…BMAs such as zoledronic acid, denosumab, and pamidronate are recommended in patients with MBC and bone metastases . In addition to lower risk of SREs with BMAs , there has been some suggestion of modest pain control with BMAs .…”

Clinical and translational pharmacology of drugs for the prevention and treatment of bone metastases and cancer‐induced bone loss

“…This approach was also supported by a meta‐analysis in which patients receiving ZA every 12 weeks had a similar risk of SRE as those receiving ZA every 4 weeks . The 12‐week administration was subsequently incorporated in the latest guidelines .…”

Bisfosfonatlar

“…2017'de ise, Amerikan Klinik Onkoloji Birliği (ASCO) ve Cancer Care Ontario (CCO), meme kanseri olgularında, kemikle ilişkili olaylarda tedavi kılavuzları yayımlamışlardır. [26] Bu kılavuzlarda, zoledronik asit ve denosumaba ek olarak pamidronatın da kullanılması önerilmektedir. Ancak, tedavi süresi hakkında halen bir görüş birliği bulunmamaktadır.…”