Side effects of bone-targeted therapies in advanced breast cancer

Breast Care
Christoph Domschke, Florian Schuetz

Abstract

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-phas...Continue Reading

Citations

Jul 17, 2020·The Journal of Clinical Endocrinology and Metabolism·Tilman D RachnerLorenz C Hofbauer
Jan 13, 2017·Supportive Care in Cancer : Official Journal of the Multinational Association of Supportive Care in Cancer·Jean-Jacques BodyGiuseppe Tonini
Jan 1, 2016·Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association·Jolanta MalyszkoJacek Malyszko
Mar 20, 2021·Curēus·Charumathi Raghu SubramanianBahar Moftakhar
May 29, 2021·International Journal of Nanomedicine·Sasmita SamalMamoni Dash

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