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Ann Oncol. 2016 Mar;27(3):379-90. doi: 10.1093/annonc/mdv617. Epub 2015 Dec 17.

Adjuvant bisphosphonates in early breast cancer: consensus guidance for clinical practice from a European Panel.

Author information

1
Department of Bone Oncology, Endocrinology and Reproductive Medicine, Philipps-University of Marburg, Frankfurt, Germany.
2
Academic Unit of Clinical Oncology, Weston Park Hospital, University of Sheffield, Sheffield r.e.coleman@sheffield.ac.uk.
3
Academic Unit of Clinical Oncology, Weston Park Hospital, University of Sheffield, Sheffield.
4
Cancer Centre London, Wimbledon, UK.
5
INSERM, Research Unit UMR403, University of Lyon, School of Medicine Lyon-Est, Lyon, France.
6
Breast Center of the Multidisciplinary Oncology Institute, Genolier, Switzerland.
7
Hospital de Santa Maria & Lisbon School of Medicine, Institute of Molecular Biology, Lisbon, Potugal.
8
CHU Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium.
9
Medical School, National University of Athens, Athens, Greece.
10
Medical Oncology, University Campus Bio-medico, Rome, Italy.
11
Institute for Gynaecological Oncology, Centre for Comprehensive Gynecology, Mannheim, Germany.
12
Sandro Pitigliani Medical Oncology Unit, Department of Oncology, Hospital of Prato, Prato, Italy.
13
University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh.
14
Institute of Oncology, Bexley Wing, St James Hospital Leeds, Leeds.
15
The Royal Marsden Hospital and Institute of Cancer Research, London, UK.
16
Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
17
Clinical Trials and Epidemiological Unit, University of Oxford, Oxford, UK.
18
Breast Center, Department of Obstetrics and Gynaecology, University of Munich, Munich, Germany.
19
Kantonsspital St Gallen, Breast Center, St Gallen, Switzerland.
20
Interdisciplinary Breast Cancer Center HELIOS Klinikum Berlin-Buch Germany, Gynecologic Oncology and Obstetrics, Berlin, Germany.
21
Department of Oncology, Vall d'Hebron Institute of Oncology (VHIO), Barcelona.
22
Department of Medical Oncology, Institute of Investigation Sanitaria Gregorio Marañón, University Complutense, Madrid, Spain.
23
Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy.
24
Danish Breast Cancer Cooperative Group Statistical Center Department of Oncology Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
25
Karolinska Institute and University Hospital, Stockholm, Sweden.
26
Institute for Obstetrics and Gynaecology, Goethe University, Frankfurt, Germany.

Abstract

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.

KEYWORDS:

adjuvant; bisphosphonates; breast cancer; guidelines

PMID:
26681681
DOI:
10.1093/annonc/mdv617
[Indexed for MEDLINE]

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