Key Points
➤ In women, breast cancer is the most common cancer, accounting for
approximately 25% of all cancers.
➤ Despite improvements in long-term outcomes for early breast cancer,
recurrence and death rates are still significant.
➤ Bone remains the most common site of breast cancer recurrence.
➤ Where benefit exists, the value of adjuvant bone-targeted therapy tends to
be in women with a "low estrogen environment," either through menopause
or suppression of ovarian function.
Treatment
Recommendation 1
➤ It is recommended that administration of bisphosphonates as adjuvant
therapy be considered for postmenopausal patients (including patients
premenopausal prior to treatment who have menopause induced by ovarian
suppression as detailed in Recommendation 5) with breast cancer deemed
candidates for adjuvant systemic therapy.
• The final decision whether or not to administer bisphosphonates should be made
during consultation between the patient and oncologist, taking into account patient and
disease characteristics including risk of recurrence, and weighing the potential benefits
and risks (adverse effects).
Recommendation 2
➤ Zoledronic acid and clodronate are the recommended bisphosphonates for
adjuvant therapy in breast cancer.
• There is need for more information comparing different agents and schedules, and
it is recommended that such trials be conducted to establish the utility and optimal
administration of other bisphosphonates for adjuvant therapy.
Recommendation 3
➤ While results for adjuvant denosumab look promising, data is insufficient
at this time to make any recommendation regarding its use in the adjuvant
setting.
• It is recommended that studies directly comparing denosumab and bisphosphonates and
evaluating administration schedules be conducted.
