Denosumab: best bone-modifying agent in setting of HR+ breast cancer and AIs?

  • Miyashita H & al.
  • Breast Cancer Res Treat
  • 21 Apr 2020

  • curated by Miriam Davis, PhD
  • Univadis Clinical Summaries
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Takeaway

  • Denosumab is linked to increased bone mineral density (BMD) and decreased fracture risk in patients with hormone receptor-positive (HR+) breast cancer who have aromatase inhibitor (AI)-induced bone loss.

Why this matters

  • AIs may be responsible for around 5% bone loss per year.
  • This network meta-analysis is the first to compare bone-modifying agents (BMAs) in this population.
  • Although the authors decline to specify the best BMA, they note that denosumab is more advantageous than other BMAs studied (denosumab or bisphosphonates zoledronate, risedronate).

Study design

  • Network meta-analysis of denosumab, zoledronate, and risedronate (16 randomized controlled trials; N=7699).
  • Funding: None disclosed.

Key results

  • Denosumab vs risedronate was linked to higher BMD (mean difference [MD], 3.29; 95% CI, 2.29-4.29) in the lumbar spine at 1 year.
  • Zoledronate vs risedronate also did well (MD, 3.10; 95% CI, 2.23-3.98).
  • Denosumab vs no treatment was linked to lower fracture risk: relative risk (RR), 0.51; 95% CI, 0.38-0.67).
  • Risedronate vs no treatment also was linked to lower fracture risk: RR, 0.54 (95% CI, 0.35-0.83).

Limitations

  • Heterogeneity across studies.