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Use of bone-modifying agents among breast cancer patients with bone metastasis: evidence from oncology practices in the US

Authors McGrath LJ, Overman RA, Reams D, Cetin K, Liede A, Narod SA, Brookhart MA, Hernandez RK

Received 23 May 2018

Accepted for publication 27 July 2018

Published 26 September 2018 Volume 2018:10 Pages 1349—1358


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Dr Vera Ehrenstein

Leah J McGrath,1 Robert A Overman,1 Diane Reams,1 Karynsa Cetin,2 Alexander Liede,3 Steven A Narod,4 M Alan Brookhart,1 Rohini K Hernandez2

1NoviSci, LLC, Durham, NC, USA; 2Amgen Inc, Thousand Oaks, CA, USA; 3Amgen Inc, South San Franscisco, CA, USA; 4Department of Medicine, University of Toronto, Toronto, Canada

Purpose: Bone-modifying agents (BMAs) are recommended for women with bone metastasis from breast cancer to prevent skeletal-related events. We examined the usage patterns and identified the factors associated with the use of BMAs (denosumab and intravenous bisphosphonates) among women in the US.
Patients and methods: Electronic health records from oncology clinics were used to identify women diagnosed with bone metastasis from breast cancer between 2013 and 2014. Patients were excluded if they had recently used a BMA or had concurrent cancer at an additional primary site. The incidence of BMA initiation, interruption, and reinitiation were estimated using competing risk regression models. A generalized linear model was used to estimate risk factors for treatment initiation and interruption.
Results: There were 589 women diagnosed with bone metastasis from breast cancer. By 1 year, 68% of these patients (95% CI: 64%, 71%) had initiated treatment with a BMA. Denosumab and zoledronic acid were the most commonly used agents, whereas pamidronate was used infrequently. Young women were more likely to initiate a BMA than older women (adjusted risk difference: 6.4 [95% CI: 1.5, 10.9]). Of the 412 patients who initiated a BMA, 46% (95% CI: 41%, 51%) experienced an interruption within 1 year. Seventy-four percent (95% CI: 68%, 79%) of patients who interrupted their treatment had reinitiated therapy within 1 year of interruption.
Conclusion: The majority of women diagnosed with bone metastasis from breast cancer initiate a BMA within 1 year of diagnosis, but a large proportion, particularly among the elderly, do not use these therapies.

Keywords: bone-modifying agents, breast cancer, bone metastasis, treatment patterns, electronic health records, denosumab, zoledronic acid, pamidronate

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