In a nutshell
The authors aimed to provide guidelines for the use of bisphosphonates (drugs used to slow or prevent bone damage) in early breast cancer. The authors concluded that bisphosphonates should be used as part of a prevention routine in at-risk patients to prevent bone loss as well as cancer recurrence and spread.
Some background
Patients with breast cancer have a number of treatment options, such as chemotherapy and hormone therapy (targets the hormones estrogen and progesterone that can be involved in cancer growth). However, such treatments can weaken the bones (bone loss) and increase the risk of fractures and breaks. Bisphosphonates are medications often used in the prevention of breaks and fractures in patients whose cancer has spread (metastasized) to the bones. Bisphosphonates are also thought to reduce the risk of cancer recurrence and spread, particularly in early breast cancer.
Methods & findings
Experts in the management of early breast cancer reviewed evidence and offered a consensus opinion on the use of bisphosphonates in patients with early breast cancer.
The panel recommended that bisphosphonates be used by all women at risk for bone loss due to cancer treatment. Calcium and vitamin D supplementation was also recommended. Studies reviewed found that zoledronic acid (Zometa) reduced bone loss in premenopausal patients who received chemotherapy or hormonal therapy. In postmenopausal women who were treated with aromatase inhibitors (treatments that reduce the production of estrogen, such as Femara), many bisphosphonates reduced bone loss. These included zoledronic acid, ibandronate (Boniva), clodronate (Bonefos), risedronate (Actonel) and alendronate (Fosamax).
Bisphosphonates can have side effects. Studies reviewed found that 70% of patients discontinue treatment within one year. Common side effects experienced included kidney issues and a breakdown of the jawbone. Side effects were more common with intravenous (delivered directly into a vein) treatment.
Bisphosphonates were recommended to reduce the risk of cancer spread in postmenopausal patients. An analysis of multiple studies, including more than 18,000 patients, found that postmenopausal women treated with zoledronic acid or clodronate had a 28% reduced risk of cancer recurrence in the bones. They also saw a 14% overall reduced risk of breast cancer recurrence and an 18% reduced risk of a distant recurrence or death due to breast cancer.
The bottom line
The authors concluded that bisphosphonates reduced bone loss in at-risk patients. Bisphosphonates also reduced cancer recurrence and spread in postmenopausal patients.
What’s next?
Discuss with your doctor whether bisphosphonates would be beneficial for your situation.
Published By :
Annals of oncology
Date :
Dec 17, 2015
