Utilizing Bisphosphonates in Breast Cancer

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The addition of a bisphosphonate to the treatment of postmenopausal women improves the 10-year overall survival rate by 3%, according to an Oxford meta-analysis presented at the San Antonio Breast Cancer Symposium. This meta-analysis supports previous data from the AZURE trial, notes Sara Hurvitz, MD. In the context of a low estrogen state, zoledronic acid appears to be protective in postmenopausal women.

Various treatment approaches exist for bisphosphonates, Hope Rugo, MD, mentions that she administers zoledronic acid every 6 months instead of taking the yearly 5-mg approach. Additionally, Rugo, Hurvitz, and Dialecti Voudouris, MD, describe the use of the RANK ligand inhibitor denosumab, which is given by subcutaneous injection. Voudouris notes that it is easy to administer, and possesses a side effect profile similar to that of the bisphosphonates. Given the risk of denosumab causing hypercalcemia, Rugo advises her patients to take 500 mg of calcium daily.

The panelists conclude the discussion by expressing their eagerness to view impending data on new therapies and pathways, such as programmed cell death protein 1 (PD-1) and poly (ADP ribose) polymerase (PARP) inhibition. Eleftherios Mamounas, MD, comments that while there are a lot of new medications, incorporating these new therapies can be challenging. Voudouris stresses that as a community oncologist, she appreciates the academicians who design and run the clinical trials in which she enrolls her patients.