Breast Cancer Update for Surgeons, Issue 1, 2017 (Video Program)Adjuvant bisphosphonates for early BC
1:53 minutes.
TRANSCRIPTION:
DR GRADISHAR: What is the evidence for use of these agents in the adjuvant setting? So specifically what we’re talking about are drugs like denosumab and bisphosphonates, which are very commonly used for metastatic disease treatment to reduce the risk of morbidities related to metastatic disease. But the more controversial, I suppose, issue is, what added benefits are there to these agents as anticancer therapy for early-stage disease? And there are, again, discordant results from trials over time that suggest maybe they’re beneficial, others that don’t show the same level of benefit. A meta-analysis has suggested that if there is a benefit, say, from bisphosphonates, the argument is most compelling in patients who have an estrogen-poor environment, such as postmenopausal women, rather than premenopausal women. So the guidelines haven’t really spoken out on this definitively. St Gallen will say something that you could consider. We’ve remained silent in the NCCN, because we don’t think we know which agent is best. How long do you give them? No trial was really definitive. But we still say that if you were to consider it, if there were some bone-related issue, sure, go ahead and do it. But there is some clear anticancer effect of these agents that can be demonstrated preclinically. And there’s also data that we’ll see with denosumab, the RANK ligand inhibitor, in this same setting. But right now, the most data we have is from a meta-analysis with the bisphosphonates suggesting that there might be a reduction in the odds of recurrence in postmenopausal women in an estrogen-deprived environment. |