PDF icon Download PDF
Open Access
CC BY-NC-ND 4.0 · South Asian J Cancer 2018; 07(02): 091-095
DOI: 10.4103/sajc.sajc_109_18
Original Article

Practical consensus recommendaton for adjuvant bone-modifying agents in breast cancer

A. Bharatuar
Department of Medical Oncology, Patel Hospital, Jallandhar, Punjab
,
M. Kar
Department of Medical Oncology, Peerless Hospital, Kolkata, West Bengal
,
S. Khatri
Department of Medical Oncology, SMH Curie Cancer Center, New Delhi
,
V. Goswami
Department of Medical Oncology, Max Hospital, Noida, Uttar Pradesh
,
R. Sarin
Department of Surgical Oncology, Indraprastha Apollo Hospital, New Delhi
,
S. Dawood
Department of Medical Oncology, Dubai Health Authority, Dubai
,
R. Iyenger
Department of Medical Oncology, Mazumdar Shaw Cancer Center, Bengaluru, Karnataka
,
M. Ganvir
Department of Medical Oncology, Sir Ganga Ram Hospital, New Delhi
,
Purvish M. Parikh
Department of Oncology, Shalby Cancer and Research Institute, Mumbai, Maharashtra
,
S. Aggarwal
Department of Medical Oncology, Sir Ganga Ram Hospital, New Delhi
,
Vineet Talwar
Department of Medical Oncology, Rajiv Gandhi Cancer Institute, New Delhi
› Author Affiliations
Financial support and sponsorship: Nil.
› Further Information
Also available ateRef
 PDF Download Permissions and Reprints
Preview

Abstract

Bone-modifying therapy is a primary research interest in breast cancer. Several features contribute to the importance of the bone environment in the management of breast cancer. Firstly, bone metastases represent the most common site of breast cancer metastases and secondly, the emergence of cancer treatment-induced bone loss (CTIBL) among breast cancer survivors and patients is of increasing concern. In the adjuvant setting, bisphosphonates can be given to prevent and treat tumor therapy-induced bone loss in premenopausal and postmenopausal women and, owing to their beneficial effect on bone turnover, have also been evaluated for prevention of bone metastases occurrence. Expert oncologists discusses on the update on the approaches of Bone-modifying Agents and its treatment options. This expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at this practical consensus recommendations for the benefit of community oncologists.

Key words

Denosumab - hormonal therapy - osteopenia - tamoxifen - zolendronic acid


Publication History

Article published online:
22 December 2020

© 2018. MedIntel Services Pvt Ltd. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 American Cancer Society. Global Cancer Facts and Figures 2nd ed. Atlanta: American Cancer Society; 2011.
  • 2 U.S. Cancer Statistics Working Group. United States Cancer Statistics: 1999–2006 Incidence and Mortality Web-Based Report. Atlanta: Department of Health and Human Services, Centers for Disease Control and Prevention, and National Cancer Institute; 2010.
  • 3 DeSantis C, Siegel R, Bandi P, Jemal A. Breast cancer statistics, 2011. CA Cancer J Clin 2011;61:409-18.
  • 4 Brufsky AM. Cancer treatment-induced bone loss: Pathophysiology and clinical perspectives. Oncologist 2008;13:187-95.
  • 5 Brufsky AM, Bosserman LD, Caradonna RR, Haley BB, Jones CM, Moore HC, et al. Zoledronic acid effectively prevents aromatase inhibitor-associated bone loss in postmenopausal women with early breast cancer receiving adjuvant letrozole: Z-FAST study 36-month follow-up results. Clin Breast Cancer 2009;9:77-85.
  • 6 Carlson RW, Allred DC, Anderson BO, Burstein HJ, Carter WB, Edge SB, et al. Breast cancer. Clinical practice guidelines in oncology. J Natl Compr Canc Netw 2009;7:122-92.
  • 7 Gnant M, Mlineritsch B, Luschin-Ebengreuth G, Kainberger F, Kässmann H, Piswanger-Sölkner JC, et al. Adjuvant endocrine therapy plus zoledronic acid in premenopausal women with early-stage breast cancer: 5-year follow-up of the ABCSG-12 bone-mineral density substudy. Lancet Oncol 2008;9:840-9.
  • 8 Gnant M, Mlineritsch B, Schippinger W, Luschin-Ebengreuth G, Pöstlberger S, Menzel C, et al. Endocrine therapy plus zoledronic acid in premenopausal breast cancer. N Engl J Med 2009;360:679-91.
  • 9 Higgins MJ, Park BH. Expanding role of bisphosphonates in the management of early breast cancer. Expert Rev Anticancer Ther 2009;9:1051-4.
  • 10 Paget S. The distribution of secondary growths in cancer of the breast 1889. Cancer Metastasis Rev 1989;8:98-101.
  • 11 Johnston AD. Pathology of metastatic tumors in bone. Clin Orthop Relat Res 1970;73:8-32.
  • 12 Coleman RE, Rubens RD. Bone metastases and breast cancer. Cancer Treat Rev 1985;12:251-70.
  • 13 National Cancer Registry Programme, Indian Council of Medical Research. Leading Sites of Cancer. In, Consolidated Report of Population Based Cancer Registries 2001-2004, Incidence and Distribution of Cancer. Bangalore: Coordinating Unit, National Cancer Registry Programme (ICMR); 2006. p. 8-30.
  • 14 Badwe RA, Gangawal S, Mitra I, Desai PB. Clinico-pathological featuresand prognosis of breast cancer in different religious communities in India. Indian J Cancer 1990;27:220-8.
  • 15 Altekruse SF, Kosary CL, Krapcho M, editors. SEER Cancer Statistics Review 1975-2007. SEER Cancer Statistics Review. National Cancer Institute.
  • 16 National Cancer Registry Program. Ten Year Consolidated Report of the Hospital Based Cancer Registries, 1984–1993, an Assessment of the Burden and Care of Cancer Patients. New Delhi: Indian Council of Medical Research; 2001.
  • 17 Agarwal G, Pradeep PV, Aggarwal V, Yip CH, Cheung PS. Spectrum of breast cancer in Asian women. World J Surg 2007;31:1031-40.
  • 18 Coleman RE. Metastatic bone disease: Clinical features, pathophysiology and treatment strategies. Cancer Treat Rev 2001;27:165-76.
  • 19 Meads MB, Hazlehurst LA, Dalton WS. The bone marrow microenvironment as a tumor sanctuary and contributor to drug resistance. Clin Cancer Res 2008;14:2519-26.
  • 20 Shiozawa Y, Havens AM, Pienta KJ, Taichman RS. The bone marrow niche: Habitat to hematopoietic and mesenchymal stem cells, and unwitting host to molecular parasites. Leukemia 2008;22:941-50.
  • 21 Coleman RE. Adjuvant bisphosphonates in breast cancer: Are we witnessing the emergence of a new therapeutic strategy? Eur J Cancer 2009;45:1909-15.
  • 22 Mundy GR. Metastasis to bone: Causes, consequences and therapeutic opportunities. Nat Rev Cancer 2002;2:584-93.
  • 23 Paget S. The distribution of secondary growths in cancer of the breast. Lancet 1889;133:571-3.
  • 24 Kyle RA, Yee GC, Somerfield MR, Flynn PJ, Halabi S, Jagannath S, et al. American Society of Clinical Oncology 2007 clinical practice guideline update on the role of bisphosphonates in multiple myeloma. J Clin Oncol 2007;25:2464-72.
  • 25 Aapro M, Abrahamsson PA, Body JJ, Coleman RE, Colomer R, Costa L, et al. Guidance on the use of bisphosphonates in solid tumours: Recommendations of an international expert panel. Ann Oncol 2008;19:420-32.
  • 26 Coleman RE. Bisphosphonates: Clinical experience. Oncologist 2004;9 Suppl 4:14-27.
  • 27 Rosen LS, Gordon DH, Dugan W Jr., Major P, Eisenberg PD, Provencher L, et al. Zoledronic acid is superior to pamidronate for the treatment of bone metastases in breast carcinoma patients with at least one osteolytic lesion. Cancer 2004;100:36-43.
  • 28 Hadji P. Aromatase inhibitor-associated bone loss in breast cancer patients is distinct from postmenopausal osteoporosis. Crit Rev Oncol Hematol 2009;69:73-82.
  • 29 Shapiro CL, Manola J, Leboff M. Ovarian failure after adjuvant chemotherapy is associated with rapid bone loss in women with early-stage breast cancer. J Clin Oncol 2001;19:3306-11.
  • 30 Hadji P, Body JJ, Aapro MS, Brufsky A, Coleman RE, Guise T, et al. Practical guidance for the management of aromatase inhibitor-associated bone loss. Ann Oncol 2008;19:1407-16.
  • 31 Colleoni M, O'Neill A, Goldhirsch A, Gelber RD, Bonetti M, Thürlimann B, et al. Identifying breast cancer patients at high risk for bone metastases. J Clin Oncol 2000;18:3925-35.
  • 32 Lønning PE. Endocrine therapy and bone loss in breast cancer: Time to close in the RANK (L)? J Clin Oncol 2008;26:4859-61.
  • 33 Perez EA, Josse RG, Pritchard KI, Ingle JN, Martino S, Findlay BP, et al. Effect of letrozole versus placebo on bone mineral density in women with primary breast cancer completing 5 or more years of adjuvant tamoxifen: A companion study to NCIC CTG MA.17. J Clin Oncol 2006;24:3629-35.
  • 34 Lønning PE, Geisler J, Krag LE, Erikstein B, Bremnes Y, Hagen AI, et al. Effects of exemestane administered for 2 years versus placebo on bone mineral density, bone biomarkers, and plasma lipids in patients with surgically resected early breast cancer. J Clin Oncol 2005;23:5126-37.
  • 35 Hershman DL, Cheung AM, Chapman JW, Ingel JN, Ahmed F, Hu H, et al. Effects of Adjuvant Exemestane Versus Anastrozole on Bone Mineral Density: Two-Year Results of the NCIC CTG MA.27 Bone Companion Study. Presented at the 2011 ASCO Annual Meeting. Chicago, IL, 3–7 June, 2011.
  • 36 Fornier MN. Denosumab: Second chapter in controlling bone metastases or a new book? J Clin Oncol 2010;28:5127-31.
  • 37 Roodman GD. Mechanisms of bone metastasis. N Engl J Med 2004;350:1655-64.
  • 38 Diel IJ, Jaschke A, Solomayer EF, Gollan C, Bastert G, Sohn C, et al. Adjuvant oral clodronate improves the overall survival of primary breast cancer patients with micrometastases to the bone marrow: A long-term follow-up. Ann Oncol 2008;19:2007-11.
  • 39 Saarto T, Blomqvist C, Virkkunen P, Elomaa I. Adjuvant clodronate treatment does not reduce the frequency of skeletal metastases in node-positive breast cancer patients: 5-year results of a randomized controlled trial. J Clin Oncol 2001;19:10-7.
  • 40 Powles T, Paterson S, Kanis JA, McCloskey E, Ashley S, Tidy A, et al. Randomized, placebo-controlled trial of clodronate in patients with primary operable breast cancer. J Clin Oncol 2002;20:3219-24.
  • 41 Green JR. Bisphosphonates: Preclinical review. Oncologist 2004;9 Suppl 4:3-13.
  • 42 Eidtmann H, de Boer R, Bundred N, Llombart-Cussac A, Davidson N, Neven P, et al. Efficacy of zoledronic acid in postmenopausal women with early breast cancer receiving adjuvant letrozole: 36-month results of the ZO-FAST study. Ann Oncol 2010;21:2188-94.
  • 43 Coleman RE, Marshall H, Cameron D, Dodwell D, Burkinshaw R, Keane M, et al. Breast-cancer adjuvant therapy with zoledronic acid. N Engl J Med 2011;365:1396-405.
  • 44 Aft R, Naughton M, Trinkaus K, Watson M, Ylagan L, Chavez-MacGregor M, et al. Effect of zoledronic acid on disseminated tumour cells in women with locally advanced breast cancer: An open label, randomised, phase 2 trial. Lancet Oncol 2010;11:421-8.
  • 45 Rack B, Jückstock J, Genss EM, Schoberth A, Schindlbeck C, Strobl B, et al. Effect of zoledronate on persisting isolated tumour cells in patients with early breast cancer. Anticancer Res 2010;30:1807-13.
  • 46 Solomayer EF, Gebauer G, Hirnle P, Janni W, Lück HJ, Becker S, et al. Influence of zoledronic acid on disseminated tumor cells in primary breast cancer patients. Ann Oncol 2012;23:2271-7.
  • 47 Bidard FC, Kirova YM, Vincent-Salomon A, Alran S, de Rycke Y, Sigal-Zafrani B, et al. Disseminated tumor cells and the risk of locoregional recurrence in nonmetastatic breast cancer. Ann Oncol 2009;20:1836-41.
  • 48 Cristofanilli M, Hayes DF, Budd GT, Ellis MJ, Stopeck A, Reuben JM, et al. Circulating tumor cells: A novel prognostic factor for newly diagnosed metastatic breast cancer. J Clin Oncol 2005;23:1420-30.
  • 49 Kim MY, Oskarsson T, Acharyya S, Nguyen DX, Zhang XH, Norton L, et al. Tumor self-seeding by circulating cancer cells. Cell 2009;139:1315-26.
  • 50 Ibrahim A, Scher N, Williams G, Sridhara R, Li N, Chen G, et al. Approval summary for zoledronic acid for treatment of multiple myeloma and cancer bone metastases. Clin Cancer Res 2003;9:2394-9.
  • 51 Hershman DL, McMahon DJ, Crew KD, Cremers S, Irani D, Cucchiara G, et al. Zoledronic acid prevents bone loss in premenopausal women undergoing adjuvant chemotherapy for early-stage breast cancer. J Clin Oncol 2008;26:4739-45.
  • 52 Shapiro CL, Halabi S, Gibson G. Effect of Zoledronic Acid (ZA) on Bone Mineral Density (BMD) in Premenopausal Women Who Develop Ovarian Failure (OF) Due to Adjuvant Chemotherapy (AdC):First Results from CALBG Trial 79809 (Oral Presentation). Presented at: 44th Annual Meeting of the American Society of Clinical Oncology. Chicago, IL, USA; 30 May–03 June, 2008.
  • 53 Rack B, Schindlbeck C, Strobl B, Sommer H, Friese K, Janni W, et al. Efficacy of zoledronate in treating persisting isolated tumor cells in bone marrow in patients with breast cancer. A phase II pilot study. Dtsch Med Wochenschr 2008;133:285-9.
  • 54 Greenberg S, Park JW, Melisko ME. Effect of adjuvant zoledronic acid (ZOL) on disseminated tumor cells (DTC) in the bone marrow (BM) of women with early-stage breast cancer (ESBC): Updated results (abstract). J Clin Oncol 2010;28 15 Suppl: 114s.
  • 55 Gnant M, Mlineritsch B, Schippinger W. Endocrine therapy plus zoledronic acid in premenopausal breast cancer. N Engl J Med 2009;360:679-91.
  • 56 Solomayer E, Gebauer G, Hirnle P. Influence of zoledronic acid on disseminated tumor cells (DTC) in primary breast cancer patients (abstract). Cancer Res 2009;69 Suppl 2:S170-1.