Bisphosphonates May Impact Bone Recurrence in Postmenopausal Women with Breast Cancer
SOURCE: Early Breast Cancer Trialists’ Collaborative Group. Adjuvant bisphosphonate treatment in early breast cancer: meta-analyses of individual patient data from randomised trials. Lancet 2015;386:1353-1361.
It has been recognized for more than a decade that selective estrogen receptor modulators may exert a protective effect on breast cancer. While typically thought of as an osteoporosis drug, raloxifene demonstrated breast cancer benefits in the Multiple Outcomes for Raloxifene Evaluation (MORE) trial. Bisphosphonates, while not possessing any known effects on estrogen receptors, could affect characteristics of bone that might reduce the likelihood of cancer cell adhesion to, or proliferation within, bone.
The Early Breast Cancer Trialists’ Collaborative Group evaluated individual patient data from randomized trials in early breast cancer in which data on bisphosphonates were available (n = 18,766). Although the rate of distant recurrence and breast cancer mortality were statistically and significantly superior in women who had been treated with bisphosphonates, the absolute degree of benefit was of dubious clinical relevance.
On the other hand, among the subgroup of postmenopausal women with breast cancer, bisphosphonates treatment was associated with meaningful (and statistically significant) reductions in overall recurrence, bone recurrence, and breast cancer mortality; similar benefits were not seen in the premenopausal population. Various bisphosphonates agents were studied in clinical trials, with no clear advantage demonstrated of one over another. Postmenopausal women with breast cancer who merit consideration of bisphosphonates for osteoporosis prevention or treatment may also enjoy risk reduction in reference to their breast cancer.
Although the rate of distant recurrence and breast cancer mortality were statistically and significantly superior in women who had been treated with bisphosphonates, the absolute degree of benefit was of dubious clinical relevance.
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