Mashari Alzahrani1, Carol Stober2, Michelle Liu2, Arif Awan1, Terry L Ng1, Gregory Pond3, Bader Alshamsan1, Lisa Vandermeer2, Mark Clemons4,5. 1. Department of Medicine, Division of Medical Oncology, The Ottawa Hospital, University of Ottawa, 501 Smyth Road, Ottawa, Canada. 2. Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, Canada. 3. Department of Oncology, McMaster University, Hamilton, Canada. 4. Department of Medicine, Division of Medical Oncology, The Ottawa Hospital, University of Ottawa, 501 Smyth Road, Ottawa, Canada. mclemons@toh.ca. 5. Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, Canada. mclemons@toh.ca.
Abstract
BACKGROUND: The effect of longer-term use of bone-modifying agent (BMA) on symptomatic skeletal event (SSE) rates in patients with bone metastases remains unclear. This retrospective study of a cohort of patients in a randomized controlled trial evaluated SSEs in patients receiving BMAs at a single cancer center. METHODS: Data from patients with metastatic breast and castration-resistant prostate cancer (CRPC) were interrogated to evaluate the effects of longer-term use of BMAs on incidence, type, and risk factors for SSEs. RESULTS: Of 162 patients, 109 (67%) had breast cancer (BC) and 53 (33%) CRPC. Median age at diagnosis of bone metastases was 61.9 years (range 27.5-97.2) for BC patients and 72.1 (range 37.0-92.2) for CRPC patients. Median duration of BMA use was 2.3 years (range 0.1-9.9 years) for BC and 3.8 years (range 1.5-9.4) for CRPC patients. The initial BMAs in BC patients were pamidronate (46.8%), denosumab (31.2%), and zoledronate (22%). All CRPC patients received denosumab. During follow-up, 59% of BC and 75% of CRPC patients had at least one SSE. The number of patients experiencing ≥ 1 SSE per year was higher in the first year after bone metastasis diagnosis (63/162; 38.9%) compared with that in the second (26/149; 17.5%) and third years (30/123; 24.4%). Neither age, visceral disease, multiple bone metastases, nor biological markers for BC had a significant impact on time to first SSE. CONCLUSIONS: The risk for SSEs was greatest in the first year after diagnosis of bone metastasis. Studies evaluating de-escalation and even stopping of BMAs with longer-term use may therefore be warranted.
BACKGROUND: The effect of longer-term use of bone-modifying agent (BMA) on symptomatic skeletal event (SSE) rates in patients with bone metastases remains unclear. This retrospective study of a cohort of patients in a randomized controlled trial evaluated SSEs in patients receiving BMAs at a single cancer center. METHODS: Data from patients with metastatic breast and castration-resistant prostate cancer (CRPC) were interrogated to evaluate the effects of longer-term use of BMAs on incidence, type, and risk factors for SSEs. RESULTS: Of 162 patients, 109 (67%) had breast cancer (BC) and 53 (33%) CRPC. Median age at diagnosis of bone metastases was 61.9 years (range 27.5-97.2) for BC patients and 72.1 (range 37.0-92.2) for CRPC patients. Median duration of BMA use was 2.3 years (range 0.1-9.9 years) for BC and 3.8 years (range 1.5-9.4) for CRPC patients. The initial BMAs in BC patients were pamidronate (46.8%), denosumab (31.2%), and zoledronate (22%). All CRPC patients received denosumab. During follow-up, 59% of BC and 75% of CRPC patients had at least one SSE. The number of patients experiencing ≥ 1 SSE per year was higher in the first year after bone metastasis diagnosis (63/162; 38.9%) compared with that in the second (26/149; 17.5%) and third years (30/123; 24.4%). Neither age, visceral disease, multiple bone metastases, nor biological markers for BC had a significant impact on time to first SSE. CONCLUSIONS: The risk for SSEs was greatest in the first year after diagnosis of bone metastasis. Studies evaluating de-escalation and even stopping of BMAs with longer-term use may therefore be warranted.
Authors: Alberto Bongiovanni; Federica Recine; Valentina Fausti; Flavia Foca; Roberto Casadei; Maria Cristina Falasconi; Devil Oboldi; Elisabetta Sansoni; Laura Fabbri; Simona Micheletti; Stefano Severi; Federica Matteucci; Venetia Zavoiu; Laura Mercatali; Dino Amadori; Toni Ibrahim Journal: Support Care Cancer Date: 2019-01-16 Impact factor: 3.603
Authors: Rebecca Dent; Wedad M Hanna; Maureen Trudeau; Ellen Rawlinson; Ping Sun; Steven A Narod Journal: Breast Cancer Res Treat Date: 2008-06-10 Impact factor: 4.872
Authors: Christian B van der Pol; Mark E Schweitzer; Gina Di Primio; Marcos L Sampaio; Ania Kielar; Mark Clemons; Arash Jaberi Journal: Breast Cancer Res Treat Date: 2014-07-10 Impact factor: 4.872
Authors: Charles S Cleeland; Jean-Jacques Body; Alison Stopeck; Roger von Moos; Lesley Fallowfield; Susan D Mathias; Donald L Patrick; Mark Clemons; Katia Tonkin; Norikazu Masuda; Allan Lipton; Richard de Boer; Stefania Salvagni; Celia Tosello Oliveira; Yi Qian; Qi Jiang; Roger Dansey; Ada Braun; Karen Chung Journal: Cancer Date: 2012-09-05 Impact factor: 6.860
Authors: Rohini K Hernandez; Sally W Wade; Adam Reich; Melissa Pirolli; Alexander Liede; Gary H Lyman Journal: BMC Cancer Date: 2018-01-06 Impact factor: 4.430
Authors: Jakub Litak; Wojciech Czyżewski; Michał Szymoniuk; Leon Sakwa; Barbara Pasierb; Joanna Litak; Zofia Hoffman; Piotr Kamieniak; Jacek Roliński Journal: Cancers (Basel) Date: 2022-09-22 Impact factor: 6.575