Scientific Publications Database

Article Title: Role of Bone-Modifying Agents in Metastatic Breast Cancer: An American Society of Clinical Oncology-Cancer Care Ontario Focused Guideline Update
Authors: Van Poznak, Catherine; Somerfield, Mark R.; Barlow, William E.; Biermann, J. Sybil; Bosserman, Linda D.; Clemons, Mark J.; Dhesy-Thind, Sukhbinder K.; Dillmon, Melissa S.; Eisen, Andrea; Frank, Elizabeth S.; Jagsi, Reshma; Jimenez, Rachel; Theriault, Richard L.; Vandenberg, Theodore A.; Yee, Gary C.; Moy, Beverly
Journal: JOURNAL OF CLINICAL ONCOLOGY Volume 35 Issue 35
Date of Publication:2017
Abstract:
PurposeTo 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.MethodsA joint ASCO-CCO Update Committee conducted targeted systematic literature reviews to identify relevant studies.ResultsThe 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.RecommendationsPatients 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 managementanalgesia, adjunct therapies, radiotherapy, surgery, systemic anticancer therapy, and referral to supportive care and pain managementbe 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.