106 Commerce Street, Suite 105
Lake Mary, FL 32746
TEL: 407.878.7606 • FAX: 407.878.7611
For additional copies, order at GuidelineCentral.com
Copyright © 2017 All rights reserved
ASCOBON1733
Disclaimer
is pocket card is derived om recommendations in the American Society of Clinical Oncology
Guideline. is resource is a practice tool based on ASCO
®
practice guidelines and is not intended
to substitute for the independent professional judgment of the treating physician. Practice guidelines
do not account for individual variation among patients. is pocket card does not purport to suggest
any particular course of medical treatment. Use of the practice guidelines and this resource are
voluntary. e practice guidelines and additional information are available atwww.asco.org/breast-
cancer-adjuvant-bisphosphonates-guideline. Copyright © 2017 by American Society of Clinical
Oncology. All rights reserved.
Abbreviations
CCO, Cancer Care Ontario; ONJ, osteonecrosis of the jaw
Source
Dhesy-ind et al. Use of Adjuvant Bisphosphonates and Other Bone-Modifying Agents in
Breast Cancer: A Cancer Care Ontario and American Society of Clinical Oncolog y Clinical
Practice Guideline. Journal of Clinical Oncolog y 2017 March 6. doi: 10.1200/JCO.2016.70.7257
[epub ahead of print].
ASCO believes that cancer clinical trials are vital to inform medical decisions and
improve cancer care and that all patients should have the opportunity to participate.
Additional information, including a data supplement, a methodolog y supplement,
slide set, and other clinical tools and resources, is available at www.asco.org/breast-cancer-
adjuvant-bisphosphonates-guideline and www.asco.org/guidelineswiki
• It is desirable to have multiple agents with different modes of administration (see
Recommendation 2)
• As with any novel therapy or new indication for existing medications, cost, access,
funding, and drug approval need to be considered in the implementation of treatment
recommendations. As mentioned in the preamble to the Practice Guideline, several health
care settings currently may have access only to bone-modifying agents to improve bone-
density or for the treatment of metastatic cancer. As such, drug formularies and governing
bodies may need to revise approved dose and scheduling parameters for these relevant
medications before clinicians may be able to utilize them. As examples in North America:
▶ Zoledronic acid has recently been added to the Cancer Care Ontario (CCO) Drug
Formulary (April 2016) for the adjuvant treatment of breast cancer in postmenopausal
women. Clodronate thus far only has Health Canada Approval for the management of
hypercalcemia of malignancy and for treatment of bone metastases and is included in the
CCO Formulary and British Columbia Cancer Agency Cancer Drug Manual for these
purposes.
▶ Zoledronic acid is approved in the United States for treatment of low bone mass and
metastatic disease, and clodronate is not available.
▶ Ibandronate is not currently approved for use in Canada. It is approved by the US FDA
for the prevention or treatment of postmenopausal osteoporosis.
▶ Direct patient cost and health system resource impact should be considered in
implementing such recommendations.
Other Considerations