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Management of bone metastasis with intravenous bisphosphonates in breast cancer: a systematic review and meta-analysis of dosing frequency
- Source :
- Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer. 28(6)
- Publication Year :
- 2019
-
Abstract
- Bisphosphonates are wildly used in breast cancer patients with bone metastasis and generally administrated every 4 weeks to lessen the risk of subsequent skeletal-related events. Bisphosphonates administration every 12 weeks is also recommended in some guidelines. Recent clinical trials suggested that bisphosphonate treatment with reduced frequency (every 12 weeks) to be non-inferior to standard therapy. The object of this analysis was to contrast the efficacy and safety of these two treatment strategies. We systematically retrieved databases such as MEDLINE, PubMed, Embase, and Cochrane library from 1947 to present for clinical trials comparing the efficacy between standard (every 4 weeks) and de-escalation (every 12 weeks) treatment of bisphosphates. We identified 4 articles with available data from 4 randomized clinical trials (n = 1721). Administration of bisphosphate every 12 weeks was non-inferior to administration every 4 weeks. There existed no significant difference in on-study skeletal-related events, renal dysfunction, and osteonecrosis of jaw. In the exploratory study, patients who received intravenous bisphosphates before enrollment experienced less on-study skeletal-related events and significant difference was observed between groups. This analysis suggested that de-escalation treatment with bisphosphates may be superior to standard treatment in terms of efficacy, safety, and economic costs. But it would be better that all the patients receive bisphosphates every 4 weeks for several months before de-escalation.
- Subjects :
- medicine.medical_specialty
MEDLINE
Bone Neoplasms
Breast Neoplasms
Cochrane Library
law.invention
03 medical and health sciences
0302 clinical medicine
Breast cancer
Randomized controlled trial
law
Internal medicine
medicine
Humans
030212 general & internal medicine
Bone Density Conservation Agents
Diphosphonates
business.industry
Standard treatment
Bone metastasis
Standard of Care
medicine.disease
Clinical trial
Oncology
030220 oncology & carcinogenesis
Meta-analysis
Female
business
Subjects
Details
- ISSN :
- 14337339
- Volume :
- 28
- Issue :
- 6
- Database :
- OpenAIRE
- Journal :
- Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
- Accession number :
- edsair.doi.dedup.....9da51ff60aa1ed1809bb820be8237dd8