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Recommendations for use of Bisphosphonates

Background

The NBOCC* Clinical practice guidelines for the management of advanced breast cancer1 define advanced breast cancer as both locally advanced and metastatic breast cancer (cancer that has spread to other parts of the body).  This topic-specific clinical practice guideline on the use of bisphosphonates for advanced breast cancer is based on evidence for women with advanced breast cancer who have bone metastases and women with locally advanced breast cancer without bone metastases.

Treatment for women with advanced breast cancer includes the use of supportive drug treatments to reduce disease-related symptoms and slow progression of disease, thereby enhancing the woman’s quality of life. Bone metastases are common in advanced breast cancer and the cancer deposits can cause bone resorption, causing bone pain, fractures, hypercalcaemia and spinal cord compression.

Bisphosphonates act to reduce the activity of bone-absorbing cells and are the standard supportive drug treatment for women with bone metastases. In women with at least one bone metastasis, bisphosphonates can be used to reduce skeletal events (defined as new bone metastases, pathological fractures, spinal cord compression, irradiation of or surgery on bone, or the development or progression of bone pain).2

There are two classes of bisphosphonates:

  • nitrogenous (alendronate, ibandronate,^ neridronate, olapadronate, pamidronate, risedronate and zoledronic acid^^) and
  • non-nitrogenous (clodronate, etidronate and tiludronate).

Bisphosphonates are administered orally or intravenously depending on the drug.

^Ibandronate is also called ibandronic acid.

^^Zoledronic acid is also called zoledronate or zolendronate.

* In July 2011, National Breast and Ovarian Cancer Centre (NBOCC) amalgamated with Cancer Australia to form a single national agency, Cancer Australia, to provide leadership in cancer control and improve outcomes for Australians affected by cancer.

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