Breast Cancer: Bisphosphonates for Early Stage Disease?

intravenous IV chemotherapy

Yes, these “bone hardening” drugs (such as zoledronic acid) can reduce the risk of recurrence and distant spread, at least among women who are post-menopausal. A meta-analysis (study of studies) of over 22,000 women showed the use of bisphosphonate drugs (after breast cancer surgery) reduced the risk of recurrence by 34% and the risk of breast cancer death by 17% in postmenopausal women. The Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) reported these potentially practice-changing results at the 2013 San Antonio Breast Symposium (USA).

The Study: Adjuvant (after surgery) bisphosphonates achieved reduction in bone recurrence and breast cancer deaths in postmenopausal women, regardless of estrogen receptor or nodal status. It did not matter whether the women had received chemotherapy or not. The drugs had no effects on disease outcome among premenopausal women. Let’s look at the results, with and without bisphosphonates:

  • Recurrence rate: 25.4% with bisphosphonates versus 26.6% without the drug
  • Distant relapse (metastasis) rates: 20.9% with the drug, and 22.3% without it
  • Bone recurrence: 6.9% with the drug, and 8.4% without it
  • Non-bone recurrence rate: 15%, with or without the drug

Perhaps most impressive are these results: Among postmenopausal women, the 10-year rate of death from breast cancer was 15.2% for those treated with bisphosphonates, compared to 18.3% for those receiving no bisphosphonate therapy. The corresponding risks of death from any cause were 21.5% versus 23.8%, respectively.

My Take: These results are striking in postmenopausal women. Will oncologists offer bisphosphonates to postmenopausal women with invasive breast cancer? Guidelines often drive treatment, and I look forward to seeing the bisphosphonates incorporated soon. For now, we can take heart in the fantastic improvements in breast cancer management over the last several decades: Estrogen “blockers” such as tamoxifen and the aromatase inhibitors (AIs) improve survival by nearly a third; Herceptin (trastazumab) by nearly a third for HER2-positive breast cancer, and now this study.

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad:  Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minute; Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

Reference: Coleman R, et al: Effects of bisphosphonate treatment on recurrence and cause-specific mortality in women with early breast cancer: A meta-analysis of individual patient data from randomized trials. 2013 San Antonio Breast Cancer Symposium. Abstract S4-07, Presented December 12, 2013.

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Harvard AB Yale MD UPenn Radiation Oncology Radiation Oncologist, Seattle area

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