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

• DOI: 10.1200/jco.2017.75.4614
• Publication Date: 2017-10-16T20:08:51Z
• Authors: Catherine Van Poznak; Mark R. Somerfield; William E. Barlow; J. Sybil Biermann; Linda D. Bosserman; Mark J. Clemons; Sukhbinder K. Dhe...; Melissa S. Dillmon; Andrea Eisen; Elizabeth S. Frank; Reshma Jagsi; Rachel Jimenez; Richard L. Theriault; Theodore A. Vande...; Gary C. Yee; Beverly Moy
• Keywords: Bone Density Conservation Agents; Diphosphonates; Imidazoles; Pamidronate; Bone Neoplasms; Breast Neoplasms; Zoledronic Acid; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; Clinical Trials, Phase III as Topic; Humans; Female; Denosumab; Randomized Controlled Trials as Topic

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 .