Van Poznak, C.H., Temin, S., Yee, G.C., Janjan, N.A., Barlow, W.E., Bierman, J.S., . . . Von Roenn, J.H., (2011). American Society of Clinical Oncology clinical practice guideline update on the role of bone-modifying agents in metastatic breast cancer. Retrieved from http://www.asco.org/sites/www.asco.org/files/full_bma_gline_u5209.pdf

To update the American Society of Clinical Oncology Guidelines regarding the role of bone-modifying agents (BMAs) in the treatment of metastatic breast cancer

Databases searched were MEDLINE and the Cochrane Library to July 2009. Investigators performed a supplemental search of items published through November 2010. Studies selected were those in which patients were randomly assigned to receive a BMA or placebo or alternative intervention. Subjects had metastatic breast cancer. Recommendations were developed by consensus following review of the evidence.

The clinical guideline update made the recommendations that follow.

• BMAs are recommended for patients with metastatic breast cancer who show evidence of bone destruction.
• No specific BMA is recommended over another. Dosage recommendations for specific agents follow.
  • Denosumab: 120 mg subcutaneously every four weeks.
  • IV pamidronate: 90 mg over at least two hours every 3–4 weeks.
  • IV zoledronic acid: 4 mg over at least 15 minutes every 3-4 weeks.
• The guideline recommends dosage, intervals, and monitoring in patients with reduced creatinine clearance levels.
• All patients should have a dental examination and preventive dental care prior to using a BMA.
• The standard of care for pain and a BMA should be provided at the onset of cancer bone pain.
• BMAs are an adjunctive therapy for cancer-related bone pain, not a first-line pain management

Bone-modifying agents are recommended for patients with metastatic breast cancer who have evidence of bone destruction as an adjunct to standard pain management.