Most physicians are de-escalating bone modifying agents in patients with bone metastases from breast and prostate cancer (J Bone Oncol. 2020;26:100339. Published 2020 Nov 10. doi:10.1016/j.jbo.2020.100339).
“There remain questions around the optimal use of bone-modifying agents in patients with bone metastases from breast and castration-resistant prostate cancer,” wrote Mashari AlZahrani, Department of Medicine, Division of Medical Oncology, The Ottawa Hospital and the University of Ottawa, Canada, and colleagues.
A survey was conducted to collect physician demographics, current practice patterns, perception on risk of symptomatic skeletal events and bone-modifying agent-associated toxicities, and attitudes towards further de-escalation 2 years post-treatment.
A total of 65 physicians completed the survey: 35 treated breast cancer, 25 treated prostate cancer, and 5 treated both.
The most common bone-modifying agent regimens in patients with no limitation in drug coverage were denosumab every 4 weeks for 3 to 4 months followed by a de-escalation to every 12 weeks in breast cancer and denosumab every 4 weeks in prostate cancer.
The most common bone-modifying agent regimens in patients with provincial health coverage were zoledronate every 4 weeks for 3 to 4 months followed by de-escalation to every 12 weeks in breast cancer and denosumab every 4 weeks in prostate cancer.
In both breast and prostate cancer, there was equal interest regarding the benefit of continuing bone-modifying agents further than 2 years. Further trials of de-escalation of bone-modifying agents in both diseases was also of interest.
“Despite their extensive use and costs, questions around optimal use of [bone-modifying agents] still exist. Practice varies according to patient insurance coverage. However, most physicians are de-escalating [bone-modifying agents],” Dr AlZahrani and colleagues concluded.—Lisa Kuhns
