Prevention for Triple Negs
Trends toward bisphosphonate use among ER+ women are galloping along. Aredia, Zometa etc. are even used as a preventative for bone mets. Keeping the bones strong and resistant to tumor activity is becoming the norm.
But what about us Triple Negs? Granted, often there is organ involvement with mets, but it's not unusual to get bones or a combo. Here is a research paper that shows why YOU may want to approach your oncologist with a little prevention. Prevention is GOOD.
Potential antitumor effects of nitrogen-containing bisphosphonate in hormone receptor negative breast cancer patients with bone metastases
In Hae Park , Jungsil Ro , Byung Ho Nam , Youngmi Kwon and Keun Seok Lee
BMC Cancer 2009, 9:154doi:10.1186/1471-2407-9-154
Published:20 May 2009
Abstract (provisional)
Background
This retrospective study evaluated, according to hormone receptor status, the antitumor effects of bisphosphonate in breast cancer patients with metastatic bone disease.
Methods
Of 317 patients with initial bone metastasis and known breast cancer subtypes, 230 patients (72.6%) had hormone receptor (HR) positive tumors, and 87 patients (27.4%) had HR negative tumors. We assessed the primary outcome of overall survival (OS), after adjusting for other factors, comparing a group that received bisphosphonates (BPs) with a group that did not receive it.
Results
87.8% of HR positive and 69.0% of HR negative patients received BPs with a median number of 17.7 cycles. Although BPs treatment made no survival benefit in HR positive group, HR negative patients showed a significant prolonged survival when they received BPs treatment (hazard ratio=0.56 [95% CI 0.34 to 0.91], P = 0.019). In multivariate analysis, disease free interval > 2 years (P = 0.036), a sum of metastatic sites < 3 (P = 0.034), and BP treatments (P = 0.007) were significant factors for survival in HR negative patients. Conclusions: Bisphosphonate treatment can result in a survival benefit in metastatic breast cancer patients with HR negative tumors.
Lisa
Comments
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Lisa, it would only make sense to me that someone should be studying the benefits of BP therapy on HR negative patients in Stages I, II and III also, since it is almost becoming standard of care to give BP to all HR+ patients since the benefits are much more far reaching then just benefits to the bones because of AI treatment.
I am on 4 mg. Zometa every six months, and if I were triple negative, I think I would be bugging my onc to put me on this treatment.
I beileve the original studies were to find out how soon to start the BP treatment on people taking AI's and it was an unsuspected finding that the BP treatment also lowered rate of recurrence.
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My tumor was also TN and my onc put me on Zometa every six months.
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I think there has been very little study on BPs and TNs because most of these studies were on women on AIs or Tamoxifen. I'm not an expert, but I suspect Zometa would be a good benefit for TNs. So, ladies, lets all hit up on our Oncs and researchers on this!
On a related note: I'm also on Zometa every six months and I'm "marginally" ER/PR positive. I'm in the US, and the only reason why I was able to get BP therapy is because I have osteopenia and am on an AI.
Thanks for the research post.
defeatbc
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hoc
Are you on Tamoxifen also since you are marginally positive for it?
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I'm TN and had stage 1, grade 3 breast cancer, with no node involvement, with a history of mother and grandmother dying of breast cancer which spread to the bone, and my medical oncologist at UCSF recommended zometa for six months. he said my chances of recurrence are already at less than 5% because i had a bilateral mast, chemo (AC/T) and a having 35 tomotherapy radiation treatments, so i decided against zometa because of the risk of osteonecrosis, albeit a low risk. i'm happy with a less than 5% chance of recurrence, although i think if i were younger, i might consider taking the zometa.
to address the specific question about Zometa for TN, here is Susan Love's analysis:
http://www.dslrf.org/breastcancer/content.asp?CATID=0&L2=6&L3=1&L4=1&PID=&sid=213&cid=1443
here is a great site for updates on TN research:
http://www.hormonenegative.blogspot.com/
and of course the triple negative foundation website, tncbfoundation.org
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Hi Ddlatt
What is osteonecrosis? How low is that risk? Were your Mother and Grandmother discovered at late stage and were ER+? Did you do a gene test? (Sorry to ask so many questions.)
I decided to take Zometa because I don't want to take chances and my doctor said the risk of other complications from Zometa is very low, so I took it. I hope I made the right decision......I am now doing also radiation treatment about 27 shots. My doctors did not recommend it to me but I thought I don't want to take chances either so went also for the rads.
Why your recurrence risk is 5%? How did you doc come up with it? My stats are similar to yours, but my doc gave me a 15% risk of recurrence.
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newalex: this is a link to osteonecrosis:
http://www.niams.nih.gov/Health_Info/Osteonecrosis/default.asp
what specifically concerns me is osteonecrosis of the jaw. google it to see photos. it's really awful, and not curable. but the risk is very low! i don't want to alarm you! it mostly occurs in people who have dental problems and extractions. i don't have any dental problems, but i just don't want any more stuff in my body and i don't want to risk osteonecrosis.
my mother and grandmother were diagnosed in their mid-sixties and died two years after diagnosis and chemo when the breast cancer spread to the bone.
i will be getting a gene test, yes.
my med onc at UCSF told me my risk is less than 5%, based on adjuvant online - taking into account bilateral mastectomy, chemo, 35 tomotherapy radiation treatments. but in reality, i think of recurrence as a 0% or 100% chance. i think all these low numbers are reassuring, but i don't think anyone really knows.
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Hi ddlat,
I'm new to these boards, and the whole triple negative experience. My Mom was also diagnosed in her early 60's, and got bone and liver mets 12 years later. She lived for three years after that, and passed away, it will be 7 years the 22nd. She got osteonecrosis of her jaw while she was dealing with the mets, It wasn't a pretty sight, but there wasn't much they could do about it at that point. She was on Fosamax for osteoperosis, and they have said since then that it can cause osteonecrosis too. If you read everything on some of these meds, it makes you not want to take anything, guess you just have to do the risk/benefit thing and try to figure out what is best.
I've enjoyed reading these boards, imagine I'll be around more, start my chemo tomorrow
Tamara
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