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Evidence summaries

Bisphosphonates in Breast Cancer

Bisphosphonates reduce the risk of skeletal events in women with advanced breast cancer and clinically evident bone metastases. Level of evidence: "A"

A Cochrane review [Abstract] 1 included 44 studies. In patients with advanced breast cancer and bone metastases (9 studies, 2810 women), bisphosphonates reduced the risk of developing a skeletal event by 14% , increased the time to skeletal event, and reduced bone pain compared with placebo or no bisphosphonates T1.

Bisphosphonates compared to placebo/observation for women with metastatic breast cancer with bone metastases

Outcome (Follow-up 12 months to 24 months)Relative effect(95% CI)Risk with placebo/observationRisk with intervention - bisphosphonates (95% CI)of participants(studies) Quality of evidence
Skeletal-related eventRR 0.86(0.78 to 0.95)640 per 1000550 per 1000(499 to 608)2810(9) High
Median time to a skeletal-related eventMedian ratio 1.43 (1.29 to 1.58)4.9 to 14.9 months8.7 to 20.8 months2810(9) High
Overall survival (Risk of death)RR 1.01(0.91 to 1.11)575 per 1000581 per 1000(523 to 638)1935(7) Moderate
Bone pain(Brief Pain Inventory,VAS and other validated or unvalidated scales-Bone pain was significantly reduced compared to placebo (in 6 out of 11 studies) and was reduced inon-significantly in another 3 studies3297(11) Moderate

In postmenopausal women with early breast cancer bisphosphonates reduced the incidence of bone metastases and increased overall survival. However this was a post-hoc subgroup analysis.

    References

    • O'Carrigan B, Wong MH, Willson ML et al. Bisphosphonates and other bone agents for breast cancer. Cochrane Database Syst Rev 2017;(10):CD003474. [PubMed]

Primary/Secondary Keywords