Debu Tripathy, MD, co-leader, Women's Cancer Program, University of Southern California Norris Comprehensive Cancer Center, discusses using adjuvant bisphosphonates as a treatment option for patients with breast cancer.
Tripathy says there has been a long-standing interest in bisphosphonates. Bisphosphonates inhibit osteoclast and bone turnover. In addition to being an effective osteoporosis treatment, bisphosphonates also lower the complication rate in patients with bone metastasis, Tripathy says.
Because of the nature of bisphosphonates, it has been hypothesized that there may be an adjuvant benefit in patients with early-stage breast cancer. Studies of the bisphosphonate zoledronate have been mixed, Tripathy says. The results have generally been negative, but when looking at the results of studies in postmenopausal patients or studies of patients who are receiving ovarian blockade, there appears to be a benefit.
An overview analysis of bisphosphonate trials showed that there was a clear improvement in outcome, particularly in postmenopausal patients in terms of metastatic disease and bone metastasis, Tripathy says.
The question now, Tripathy says, is how to interpret this data. Since the benefits seen from the bisphosphonate trials in terms of mortality is comparable to the range seen with adjuvant chemotherapy, the professional community needs to deliberate over the data, says Tripathy. New ASCO guidelines should address the issue of bisphosphonates when they are update.
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