bisphosphonates

starwoman

http://www.theguardian.com/society/2015/jul/24/cheap-osteoporosis-drug-prevent-breast-cancer-deaths-study

Researchers said that bisphosphonates, which are given to keep people's bones healthy, prevented one in six breast cancer deaths in postmenopausal women over the course of a decade.

Trials showed that the drugs stopped breast tumour cells from spreading to the bones, the most common site for secondary cancers, and reduced the risk of dying from the disease by 18% in the first ten years after diagnosis

cp418

http://www.thelancet.com/journals/lancet/article/P...(15)60908-4/abstract

Adjuvant bisphosphonate treatment in early breast cancer: meta-analyses of individual patient data from randomised trials

JohnSmith

Quick comment / questions.

I'm overwhelmed with researching other topics (and distracted by my day job) and know nothing about bisphosphonates, so perhaps others can add more relevance to this thread.

1. Is this bisphosphonate data relevant for pre-menapausal?
2. Are bisphosphonates "Over The Counter" (OTC) or Prescription in the USA?
2a. If OTC, what's the common brand names?
2b. If prescription, ditto?
3. If OTC, what are common daily dosages?
4. What / where are the clinical trial links?

Thanks

MusicLover

JS, This seems like it only applies to post menopausal women. I believe that they are prescription only and some require an infusion like Zometa, Xgeva is an injection and there are others. Maybe others will answer your questions but I think it is best to ask your wife's onc. I just wanted to let you know that they are some nasty side effects with these drugs like ONJ that you probably have seen women talk about on here. So if you do ask onc be prepared for him/her to tell you that. Best wishes.

(I honestly wonder how they are able to determine what is going to help and what is going to hurt, maybe there is a clinical trial to give us these answers. Hopefully someone an tell you about that.)

glennie19

JS:  these meds are RX in the US.  Common brand names for oral ones are:  Fosamax, Actonel, Boniva.  Zometa is IV infusion and Xgeva is a sub-q shot. 

starwoman

John - there is a list of the trials on pages 42-43 in this appendix http://www.thelancet.com/cms/attachment/2034941148/2050223391/mmc1.pdf

The benefit does seem to apply only to post-menopausal women.

I find it hard to extract the absolute (rather than relative) benefit from the Lancet article. Perhaps a statistically knowledgeable person could help with that. I agree the potential side-effects you mention MusicLover need to be taken into account. Regarding ONJ, the article states:

From the data provided, we were unable to assess the incidence of osteonecrosis of the jaw, but previous reports suggest it ranges from under 1% with clodronate, ibandronate, or 6-monthly zoledronic acid^{12, 13 and 29} to about 2% with more intensive zoledronic acid schedules.³⁰

MusicLover

Starwoman, Can you further explain that last statement for me? Are the oral types in the first group? and the others are in the second group? Still 1-2% is not bad, no? I recently created a thread which states that my onc moved me from every 4 weeks to every 12 weeks for Zometa infusions. Thanks for your help.

exbrnxgrl

JS,
Ditto to what everyone else has said . When I was on a bisphosphonate, it was pamidronate (Aredia), which is an older drug. I was just at my mo today and she mentioned that her medical practice no longer uses it and has gone to Zometa. Yes, they are all prescription. In addition to possible ONJ, there have been reports of increases in spontaneous femur fractures. The chances of experiencing these se's seem to increase the longer the drugs are used. This has lead to some reevaluation of frequency of administration and/or overall length of course of treatment. If you Google bisphosphonate, you'll find a lot of info.

exbrnxgrl

Here is an article I read with my mo today:

http://www.medscape.com/viewarticle/825995

starwoman

MusicLover - I just lifted that last sentence straight from the publication so can't elaborate - sorry. It's close to the very end of the article http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(15)60908-4.pdf

I am resisting my GP's recommendation for a bone drug and am wondering if the findings in this article might change my view.

coraleliz

This is only looking 10years out. Some of us have cancers that are not likely to reoccur in that time period. So, if we agree to take a biphosonate now, and live long enough & develop osteoporosis(OK, for me it's inevitable given my family history), will there be anything for us to treat our thinning bones with (when it might really be needed)? Another risk to weigh........I should be better at this by now

Kathy044

I will have to go and have a look at this study. We really really need to consider the absolute benefit for those of us with an early stage cancer before jumping in on this imo.

I learned that I had osteoporosis when I started on Arimidex five years ago and so was told that I had to start taking a bone drug. I took Etidrondate a bisphosphate for two and a half years then switched to Prolia after fracturing my wrist. Last month I had my fourth six month injection and that will certainly be my last as risk of ONJ, though rare, is cumulative over time, and according to my oral surgeon remains for life.

Btw Prolia, known as Xgeva when used for cancer is not a bisphosphate but has the same risk of ONJ though does not have the same risk of brittle bone after five years that the bisphosphates have.

BCO reported on a study on using Prolia to reduce fracture risk for women with early stage cancer on AIs even those with normal bone density. I am concerned where all this is leading. Possible benefit to prevent cancer recurrence is briefly mentioned (eta, not here but in the journal abstract and other media releases, also the safety analysis)

https://community.breastcancer.org/forum/120/topic/832707?page=1#idx_

Kathy

starwoman

Can anyone confirm that the graphs in figure 3 on page 6 give the absolute numbers?

If this is a correct understanding, within the postmenopausal group of 11,676 women, at the end of 10 years, those taking bisphosphonates would have:

2.2% fewer bone recurrences (6.6% vs 8.8%)

1.6% fewer non-bone recurrences (12.1% vs 13.6%)

3.3% less deaths (14.7% vs 18%)

I didn't realise the risk of ONJ remains for life following bisphosphonate use. Prolia is what my GP would like to prescribe (already osteopenic when beginning arimidex and doing an 18 month dexa next month to see what's happening). I know it has a different mechanism of action to bisphosphonates.

For osteopenia / osteoporosis, I'm interested in the results of the Canadian COMB study http://www.hindawi.com/journals/jeph/2012/354151/ .