Breast cancer bone mets: meta-analysis supports zoledronate de-escalation

  • Awan AA & al.
  • Breast Cancer Res Treat
  • 1 Aug 2019

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • A meta-analysis suggests that de-escalation of zoledronate from every 4 weeks to every 12 weeks in patients with bone metastases from breast cancer is associated with:
    • lower toxicity-related discontinuations and
    • similar rates of patients with ≥1 skeletal-related event (SREs), skeletal morbidity, and time to first SRE.

Why this matters

  • De-escalation can reduce toxicity, cost, and patient visits, and improve compliance.

Study design

  • A meta-analysis of 8 reported studies and 1 abstract comprising data from 5 completed randomized clinical trials including 1807 patients with breast cancer.
  • Funding: No external funding.

Key results

  • Zoledronate administration every 12 vs 4 weeks did not significantly affect:
    • Incidence of ≥1 on-study SRE (summary risk ratio [RR], 1.05; 95% CI, 0.88-1.25).
    • Time to first SRE (summary RR, 1.06; 95% CI, 0.70-1.60).
    • Skeletal morbidity rate (quantitative analysis was not performed because of reporting heterogeneity).
  • Prior intravenous bisphosphonate did not affect results (summary RR, 1.04; 95% CI, 0.88-1.24).
  • De-escalation was not associated with increased risk for:
    • Jaw osteonecrosis (summary RR, 0.59; 95% CI, 0.30-1.17).
    • Increased creatinine (summary RR, 0.41; 95% CI, 0.15-1.16).
  • Adverse event-related treatment discontinuation rates were significantly lower in the de-escalated group (2.8% vs 5.5%; RR, 0.51; 95% CI, 0.30-0.89)

Limitations

  • Insufficient data on bone-modifying agents other than zoledronate.