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The Oncologist Apr 2015Complications from skeletal-related events (SREs) constitute a challenge in the care of cancer patients with bone metastasis (BM). (Comparative Study)
Comparative Study Meta-Analysis
Systematic literature review and network meta-analysis comparing bone-targeted agents for the prevention of skeletal-related events in cancer patients with bone metastasis.
BACKGROUND
Complications from skeletal-related events (SREs) constitute a challenge in the care of cancer patients with bone metastasis (BM).
OBJECTIVES
This study evaluated the comparative effectiveness of pamidronate, ibandronate, zoledronate, and denosumab in reducing the morbidity of SREs in cancer patients with BM.
METHODS
Medline (1948 to January 2014), Embase (1980 to January 2014), the Cochrane Library (2014 issue 1), and Web of Science with Conference Proceedings (1970 to January 2014) were searched. Only randomized controlled trials assessing denosumab, bisphosphonates, or placebo in cancer patients with BM were included. The primary outcomes were SREs and SREs by type. The network meta-analysis (NMA) was performed with a random-effects Bayesian model.
RESULTS
The NMA included 14 trials with 10,192 patients. Denosumab was superior to placebo in reducing the risk of SREs (odds ratio [OR]: 0.49; 95% confidence interval [CI]: 0.31-0.75), followed by zoledronate (OR: 0.57; 95% CI: 0.41-0.77) and pamidronate (OR: 0.55; 95% CI: 0.41-0.72). Ibandronate compared with placebo could not reduce the risk of SREs. Denosumab was superior to placebo in reducing the risk of pathologic fractures (OR: 0.50; 95% CI: 0.32-0.79), followed by zoledronate (OR: 0.61; 95% CI: 0.43-0.86). Denosumab was superior to placebo in reducing the risk of radiation (OR: 0.51; 95% CI: 0.35-0.75), followed by pamidronate (OR: 0.67; 95% CI: 0.52-0.86) and zoledronate (OR: 0.70; 95% CI: 0.52-0.96).
CONCLUSION
This NMA showed that denosumab, zoledronate, and pamidronate were generally effective in preventing SREs in cancer patients with BM. Denosumab and zoledronate were also associated with reductions in the risk of pathologic fractures and radiation compared with placebo. Denosumab was shown to be the most effective of the bone-targeted agents.
Topics: Bone Density Conservation Agents; Bone Diseases; Bone Neoplasms; Denosumab; Diphosphonates; Humans; Ibandronic Acid; Imidazoles; Neoplasms; Pamidronate; Spinal Cord Compression; Treatment Outcome; Zoledronic Acid
PubMed: 25732263
DOI: 10.1634/theoncologist.2014-0328 -
Journal of Oral and Maxillofacial... May 2012Bisphosphonate therapy is widely used for the treatment of bone metastasis in breast cancer patients.
BACKGROUND
Bisphosphonate therapy is widely used for the treatment of bone metastasis in breast cancer patients.
AIM
The aim of this study is to estimate the overall prevalence of bisphosphonate induced osteonecrosis of jaw (BONJ) in breast cancer patients with bone metastasis.
MATERIALS AND METHODS
A literature review was conducted to search and evaluate all the articles that contained original data on the prevalence of BONJ in breast cancer patients from the year 2003-2009. Pubmed search terms used were bisphosphonate, osteonecrosis, breast cancer and jaw. Eleven publications that fulfilled the inclusion criteria were chosen for the study. Case reports and reviews were excluded from the analysis based on assessing the title and abstract.
RESULTS
Of the 2490 breast cancer patients, 69 developed BONJ with the overall prevalence rate of 2.8%. All the patients with BONJ had received zoledronate or pamidronate, either alone or in combinations.
CONCLUSION
BONJ is a significant complication occurring in 2.8% of the breast cancer patients receiving bisphosphonates for metastatic bone disease. It is very important to identify the trigger factors associated with BONJ and also to establish guidelines for the prevention and effective treatment of this condition.
PubMed: 22923892
DOI: 10.4103/0973-029X.98893