Managing Skeletal-Related Events in Breast Cancer, Part II

Panelists: William J. Gradishar, MD, Northwestern;Joyce O’Shaughnessy, MD, Texas Oncology;
Christy A. Russell, MD, USC Norris; Debu Tripathy, MD, USC Norris;
Linda Vahdat, MD, Weill Cornell Medical College
Published Online: Tuesday, December 11, 2012
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One of the challenges facing the management of skeletal-related events (SREs) is determining the correct antiresorptive therapy and setting for women with breast cancer. Further complicating the issue, varying data and controversy exist concerning the use of calcium, vitamin D, and bisphosphonates.

Christy A. Russell, MD, notes that she uses the NCCN guidelines for clues about possible therapy options. In general, Russell notes that she waits until patients have become significantly osteopenic before initiating treatment with an oral bisphosphonate. She adds that in general a majority of patients are not taking calcium and vitamin D, which further complicates matters.

Debu Tripathy, MD, agrees that replacing calcium and vitamin D is an essential part of the equation that has become a controversial issue. He adds that evidence on the use of vitamin D is mixed, not just in terms of bone health but also concerning lowering breast cancer risk. Linda T. Vahdat, MD, notes that simple management of vitamin D deficiency can be handle by the oncologist and she recommends more complicated cases be referred to a specialists.

Tripathy notes that information regarding administering adjuvant bisphosphonates is mixed. In general, the panel agrees that these agents seem to be most effective in postmenopausal women or in the high-risk setting but may result in complications in younger premenopausal women.

View >>> Managing Skeletal-Related Events in Breast Cancer, Part I
View More From This Discussion
Episode 1 Improving the Management of Metastatic Breast Cancer, Part I
Episode 2 Management of Metastatic Breast Cancer, Part II
Episode 3 Chemotherapy in Advanced Breast Cancer
Episode 4 Emerging Therapies in Metastatic Breast Cancer
Episode 5 Managing Skeletal-Related Events in Breast Cancer, Part I
Episode 6 Managing Skeletal-Related Events in Breast Cancer, Part II
Episode 7 Molecular and Personalized Medicine in Breast Cancer
Expert Panelists
Debu Tripathy

Debu Tripathy, MD

Co-Leader, Women's Cancer Program
USC Norris Comprehensive Cancer Center
University of Southern California
Los Angeles, California

William J. Gradishar, MD

Director, Maggie Daley Center
for Women's Cancer Care
Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois

Joyce A. O’Shaughnessy, MD

Co-Director, Breast Cancer Research
Baylor Charles A. Sammons Cancer Center
Texas Oncology, PA/US Oncology,
Dallas, Texas

Christy A. Russell, MD

Co-Director, USC Norris Breast Center
USC Norris Comprehensive Cancer Center
University of Southern California
Los Angeles, California

Linda T. Vahdat, MD

Director, Breast Cancer Research Program
Head, Solid Tumor Service
Weill Cornell Medical College
New York, New York
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