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Raghu Subramanian C, Talluri S, Mullangi S, et al. Review of Bone Modifying Agents in Metastatic Breast Cancer. Cureus. 2021;13(2):e13332doi: 10.7759/cureus.13332.
Raghu Subramanian, C., Talluri, S., Mullangi, S., Lekkala, M. R., & Moftakhar, B. (2021). Review of Bone Modifying Agents in Metastatic Breast Cancer. Cureus, 13(2), e13332. https://doi.org/10.7759/cureus.13332
Raghu Subramanian, Charumathi, et al. "Review of Bone Modifying Agents in Metastatic Breast Cancer." Cureus vol. 13,2 (2021): e13332. doi: https://doi.org/10.7759/cureus.13332
Raghu Subramanian C, Talluri S, Mullangi S, Lekkala MR, Moftakhar B. Review of Bone Modifying Agents in Metastatic Breast Cancer. Cureus. 2021 Feb 13;13(2):e13332. doi: 10.7759/cureus.13332. PMID: 33738175; PMCID: PMC7960030.
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Cureus. 2021 Feb 13;13(2):e13332. doi: 10.7759/cureus.13332.

Review of Bone Modifying Agents in Metastatic Breast Cancer.

Cureus

Charumathi Raghu Subramanian, Swapna Talluri, Sanjana Mullangi, Manidhar R Lekkala, Bahar Moftakhar

Affiliations

  1. Department of Medicine, Washington Hospital Healthcare System, Fremont, USA.
  2. Department of Medicine, Guthrie Robert Packer Hospital, Sayre, USA.
  3. Department of Medicine, Hillcrest Medical Center, Tulsa, USA.
  4. Department of Hematology/Oncology, James P Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, USA.

PMID: 33738175 PMCID: PMC7960030 DOI: 10.7759/cureus.13332

Abstract

Bone is the most common site for distant metastases in breast cancer and can cause significant morbidity and mortality. Bone modifying agents (BMAs) that include bisphosphonates (BPAs) and denosumab help in decreasing and delaying skeletal-related events (SREs) associated with metastatic breast cancer. BPAs approved for use by the Food and Drug Administration (FDA) in bone metastases (BM) in the United States are pamidronate and zolendronic acid, while clodronate and ibandronate are licensed for use in other countries. Current American Society of Clinical Oncology (ASCO) guidelines recommend denosumab 120 mg subcutaneously every four weeks, or zolendronic acid 4 mg every four weeks or every 12 weeks, or intravenous pamidronate 90 mg every four weeks. Current guidelines do not recommend one BMA over another, however, zolendronic acid and denosumab were the most commonly used BMAs in population-based studies. Side effects of BMAs include acute phase reactions, hypocalcemia, nephrotoxicity, osteonecrosis of jaw, etc. While other side effects are common with both BPAs and denosumab, the latter has less nephrotoxic potential and is preferred for use in patients with renal failure. Current ASCO guidelines recommend continuing BMAs indefinitely, however, in clinical practice, this decision needs to be individualized, especially since there is no data on the impact of long-term use of BMAs. Further studies would need to be developed to develop an algorithm of SRE risk assessment and to determine which patients would benefit from BMAs.

Copyright © 2021, Raghu Subramanian et al.

Keywords: bone modifying agents; metastatic breast cancer

Conflict of interest statement

The authors have declared that no competing interests exist.

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