Diagnosis and Treatment Algorithm Figure 1. BMAs in Metastatic Breast Cancer
Evidence of bone destruction on radiographs, CT scans, or MRI
Review calcium and vitamin D intake
Dental examination and necessary preventive dentistry
Check serum creatinine
Denosumab 120 mg subcut every 4 weeks
OR
Pamidronate 90 mg IV over ≥ 2 hours every 3 to 4 weeks
OR
Zoledronic acid 4 mg IV over ≥ 15 minutes every 3 to 4 weeks
Standard of care pain management
D/C if substantial decline in general performance status
BMA (Brand)
Table 1. FDA approved BMAs Dose
Denosumab (Xgeva™
)
Pamidronate (Aredia®
)
Zoledronic acid (Zometa®
) 120 mg subcut every 4 weeks
90 mg IV delivered over 2 hours every 3 to 4 weeks 4 mg IV over ≥ 15 minutes every 3 to 4 weeks
