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Metastatic Breast Cancer Treatment Guidelines Updated

Bone-modifying agent added; preventive dental treatment to avoid complications recommended

THURSDAY, Feb. 24 (HealthDay News) -- The American Society of Clinical Oncology has issued updated guidelines for the use of bone-modifying agents (BMAs) in treating breast cancer patients with bone metastases to include a new drug, denosumab, and provide new advice regarding a potentially serious complication of treatment, osteonecrosis of the jaw (ONJ); an overview of the guideline update was published online Feb. 22 in the Journal of Clinical Oncology.

Catherine H. Van Poznak, M.D., from the University of Michigan in Ann Arbor, and colleagues reviewed literature published between 2003 and 2010 to evaluate the role of BMAs in the prevention and treatment of skeletal-related events (SRE) in patients with metastatic breast cancer with bone metastases. Outcomes included SRE, time to SRE, adverse events, and pain.

The investigators recommended BMA therapy for breast cancer patients with bone metastases, and did not find sufficient evidence to recommend any one particular BMA. Recommended treatments include denosumab (120 mg subcutaneously), intravenous (IV) pamidronate (90 mg), or IV zoledronic acid (4 mg) every three to four weeks. Dental examination and appropriate preventive dentistry is recommended before initiation of BMA therapy as part of the advice to prevent ONJ. Pain management by current standards for cancer bone pain is recommended with the onset of pain. Use of biochemical markers to monitor BMA is not recommended.

"The Update Committee stresses the importance of communicating risks and benefits of and the rationale expected for using bone-modifying agents, including clarifying potential outcomes," the authors write. "Awareness of disparities in access to care should be considered in the context of this clinical practice guideline."

Several study authors disclosed financial relationships with pharmaceutical companies, including Amgen and Novartis, which funded this study.

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