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. 2013 Apr 15;2(2):77-83.
doi: 10.1016/j.jbo.2013.03.001. eCollection 2013 Jun.

De-escalated administration of bone-targeted agents in patients with breast and prostate cancer-A survey of Canadian oncologists

Brian Hutton  1 , Christina Addison  2 , Sasha Mazzarello  3 , Anil A Joy  4 , Nathaniel Bouganim  5 , Dean Fergusson  1 , Mark Clemons  3
Affiliations

De-escalated administration of bone-targeted agents in patients with breast and prostate cancer-A survey of Canadian oncologists

Brian Hutton et al. J Bone Oncol. .

Abstract

Objective: Questions remain regarding the optimal use of bone-targeted agents in patients with metastatic bone disease. The purpose of this study was to assess current clinical practice regarding the use and administration of bone-targeted agents by Canadian oncologists in patients with metastatic breast and prostate cancer.

Methods: A survey was designed to explore; bone-targeted agent use in metastatic bone disease, variability in the choice and the frequency of administration of these agents. Opinions were sought on potential outcomes for future trials.

Results: A total of 193 clinicians were contacted and 90 completed our survey (response rate 49% after adjustment for inactivity). Survey respondents were medical oncologists (71.1%), radiation oncologists (21.1%) and urologists (7.8%). The findings suggest that once bone-targeted agents are started they are rarely discontinued. More agents are used in breast cancer than in prostate cancer. There was considerable interest in performing studies of de-escalated therapy in both breast and prostate cancer. Physicians requested (86%) that the primary study endpoint be the occurrence of skeletal related events and not biomarker driven.

Conclusions: Despite clinical practice guidelines and widespread use, significant areas of clinical equipoise with respect to use of bone-targeted agents exist. Findings from this survey suggest that physicians are interested in de-escalated therapy for both breast and prostate patients. However, the use of multiple agents in breast cancer and the desire for skeletal related events to be the primary endpoint means that very large randomized studies will be required.

Keywords: Bisphosphonate; Bone metastasis; Bone targeted agent; Survey.

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Figures

Fig. 1
Fig. 1
Reasons for administration of bone targeted agents.
Fig. 2
Fig. 2
Summary of respondent answers, scenarios 1–5. Summary of responses to Scenarios 1–5. ‘⁎’ Scenario 5 pertains only to respondents who use bone targeted agents to treat prostate cancer patients (n=23).
Fig. 3
Fig. 3
Proportion of respondents indicating use of different bone-targeted agents to treat breast and prostate cancer patients.
Fig. 4
Fig. 4
Distribution of administration frequency of bone targeted agents, by indication. Based on n=52 breast cancer respondents and n=23 prostate cancer respondents. Those respondents who treat both types of patients contributed data for each indication.
See this image and copyright information in PMC

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