Side Effects of Bone-Targeted Therapies in Advanced Breast Cancer

Breast care

Florian Schuetz¹  Christoph Domschke¹ 

[1] Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany

关键词: Breast cancer;    Bone-targeted agents;    Bisphosphonates;    Denosumab;    Adverse events;   

DOI  :  10.1159/000368844

学科分类：泌尿医学

来源: S Karger AG

【 摘 要 】

In up to 75% of cases, advanced breast cancer patients eventually develop bone metastases with often debilitating skeletal-related events (SREs). Osteoclast inhibitors are commonly used as therapeutic mainstay with clinical studies showing superiority of denosumab over bisphosphonates (e.g., zoledronate) for the prevention of SREs. The present review discusses the adverse event profile of these agents, and addresses the prevention and management of untoward side effects. Adverse events associated with osteoclast inhibitors comprise osteonecrosis of the jaw and hypocalcemia. Hypocalcemia is more common with denosumab, particularly in severe renal dysfunction. During therapy, the appropriate prevention of these adverse events includes close attention to dental health, avoidance of invasive dental procedures, supplementation with calcium and vitamin D unless patients are hypercalcemic, and regular monitoring of relevant serum values. Relating to the risk of nephrotoxicity, bisphosphonates but not denosumab have been incriminated. Therefore, serum creatinine levels should be checked prior to each dose of zoledronate, and in severe renal dysfunction (creatinine clearance < 30 ml/min) zoledronate is contraindicated anyway. Acute-phase reactions are particularly linked to bisphosphonates. Consequently, if these adverse events predominate, switching to denosumab is recommended.

【 授权许可】

Unknown