The Use of Bisphosphonates in Patients With Breast Cancer

Catherine H. Van Poznak, MD


Cancer Control. 2002;9(6) 

In This Article

Bisphosphonates Guidelines

The American Society of Clinical Oncology (ASCO) guidelines for use of bisphosphonates in patients with metastatic breast cancer aids in directing bisphospho-nate therapy.[26] The guidelines were created before the publication of the zoledronic acid studies and before the FDA approval of zoledronic acid; therefore, the recommendations focus on pamidronate. However, questions remain regarding maximizing bisphosphonate use and the selection of patients for bisphosphonate therapy: When is the optimal time to start or stop bisphospho-nate therapy? What is the best drug, route of administration, and dosing schedule? Who are the patients most like to benefit (or not) from bisphosphonate therapy? It has been suggested that either a scoring system for rating risk of pathologic fracture[27] or monitoring markers of bone catabolism[28] may direct patient-specific therapy. However, neither of these approaches has been validated to date. The ASCO guidelines advocate that intravenous bisphosphonate therapy, once begun, be continued in conjunction with systemic therapy until there is evidence of substantial decline in the patient's performance status. At the point of significant clinical deterioration, goals of treatment generally focus on best supportive care.


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