Περίληψη:
Bisphosphonates have been studied in randomised trials in early breast cancer to investigate their ability to prevent cancer treatment-induced bone loss (CTIBL) and reduce the risk of disease recurrence and metastasis. Treatment benefits have been reported but bisphosphonates do not currently have regulatory approval for either of these potential indications. This consensus paper provides a review of the evidence and offers guidance to breast cancer clinicians on the use of bisphosphonates in early breast cancer. Using the nominal group methodology for consensus, a systematic review of the literature was augmented by a workshop held in October 2014 for breast cancer and bone specialists to present and debate the available pre-clinical and clinical evidence for the use of adjuvant bisphosphonates. This was followed by a questionnaire to all members of the writing committee to identify areas of consensus. The panel recommended that bisphosphonates should be considered as part of routine clinical practice for the prevention of CTIBL in all patients with a T score of <-2.0 or ≥ 2 clinical risk factors for fracture. Compelling evidence from a meta-analysis of trial data of >18 000 patients supports clinically significant benefits of bisphosphonates on the development of bone metastases and breast cancer mortality in post-menopausal women or those receiving ovarian suppression therapy. Therefore, the panel recommends that bisphosphonates (either intravenous zoledronic acid or oral clodronate) are considered as part of the adjuvant breast cancer treatment in this population and the potential benefits and risks discussed with relevant patients. © The Author 2015. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.
Συγγραφείς:
Hadji, P.
Coleman, R.E.
Wilson, C.
Powles, T.J.
Clézardin, P.
Aapro, M.
Costa, L.
Body, J.-J.
Markopoulos, C.
Santini, D.
Diel, I.
Di Leo, A.
Cameron, D.
Dodwell, D.
Smith, I.
Gnant, M.
Gray, R.
Harbeck, N.
Thurlimann, B.
Untch, M.
Cortes, J.
Martin, M.
Albert, U.-S.
Conte, P.-F.
Ejlertsen, B.
Bergh, J.
Kaufmann, M.
Holen, I.
Λέξεις-κλειδιά:
alendronic acid; anastrozole; aromatase inhibitor; bisphosphonic acid derivative; calcium; clodronic acid; estradiol; estrogen; goserelin; ibandronic acid; inhibin; letrozole; pamidronic acid; placebo; risedronic acid; tamoxifen; vitamin D; zoledronic acid; antineoplastic agent; bisphosphonic acid derivative; bone density conservation agent; clodronic acid; imidazole derivative; zoledronic acid, adjuvant chemotherapy; adjuvant therapy; adverse drug reaction; androgen deprivation therapy; bone density; bone metastasis; bone specialist; breast cancer; cancer combination chemotherapy; cancer hormone therapy; cancer mortality; cancer prognosis; cancer treatment induced bone loss; clinical practice; consensus; disease free survival; drug activity; drug potency; early cancer; estraosseous metastasis; European; extraosseous metastasis; fracture; hazard ratio; hormone release; human; medical specialist; meta analysis; metastasis; metastasis free survival; monotherapy; multiple cycle treatment; nonhuman; osteolysis; ovarian suppression; ovary function; overall survival; patient compliance; postmenopause; practice guideline; premenopause; priority journal; questionnaire; rating scale; recurrent disease; resistance training; Review; risk factor; systematic review; T score; treatment duration; adjuvant chemotherapy; Bone Neoplasms; Breast Neoplasms; chemically induced; Europe; female; osteoporosis; prevention and control; secondary; tumor recurrence, Antineoplastic Agents; Bone Density Conservation Agents; Bone Neoplasms; Breast Neoplasms; Chemotherapy, Adjuvant; Clodronic Acid; Consensus; Diphosphonates; Europe; Female; Humans; Imidazoles; Neoplasm Recurrence, Local; Osteoporosis; Surveys and Questionnaires
