Abstract
Purpose
The purpose of this paper is to document the use of intravenous (IV) bisphosphonates for prevention of skeletal-related events (SREs) in patients with bone metastases (BM) due to breast cancer (BC), lung cancer (LC), or prostate cancer (PC).
Methods
Using data from two large US health systems, we identified all patients aged ≥18 years with primary BC, LC, or PC and newly diagnosed BM between 1/1/1995 and 12/31/2009. Starting with the diagnosis of BM, we reviewed medical and administrative records for evidence of receipt of IV bisphosphonates (zoledronic acid or pamidronate) and occurrence of SREs. Initiation of IV bisphosphonates prior to occurrence of an SRE was designated “primary prophylaxis”; use following an SRE was designated “secondary prophylaxis”.
Results
We identified a total of 1,193 patients with newly diagnosed BM, including 400 with BC, 332 with LC, and 461 with PC. Use of IV bisphosphonates was substantially higher in BC (55.8 % of all patients) than in LC (14.8 %) or PC (20.2 %). Use of IV bisphosphonates was fairly evenly split between primary and secondary prophylaxis in BC (26.3 vs. 29.5 %, respectively) and PC (10.6 vs 9.5 %); in LC, however, primary prophylaxis was much less common than secondary prophylaxis (4.8 vs 9.9 %).
Conclusions
Almost one half of all patients with BM due to BC, and substantially more with LC and PC, do not receive IV bisphosphonates. Among patients receiving such therapy, treatment often is not initiated until after the occurrence of an SRE. Our study suggests that IV bisphosphonates may be substantially underutilized in patients with BM due to these common cancers.
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Notes
Primary bone cancer was included in the initial scan of administrative data, since the authors have found in prior work that metastatic disease to bone is sometimes miscoded.
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Conflict of interest
Dr. Oster, Dr. Edelsberg, and Ms. Lopez are employed by Policy Analysis Inc., Brookline, MA, which received study funding from Amgen Inc., Thousand Oaks, CA. Dr. Lamerato is employed by Henry Ford Health System, Detroit, MI, which received study funding from Amgen Inc.; Mr. Wolff was employed by Henry Ford Health System at the time the study was conducted. Dr. Glass and Dr. Richert-Boe are employed by Kaiser Permanente Northwest Region, Portland, OR, which received study funding from Amgen Inc.; Ms. Dodge was employed by Kaiser Permanente Northwest Region at the time the study was conducted. Dr. Balakumaran and Ms. Richhariya are employed by Amgen Inc., and may own stock or stock options in the company. Dr. Chung was employed by Amgen Inc. at the time the study was conducted. PAI has full control of all primary data and would agree to allow Supportive Care in Cancer to review the data, if requested.
Financial support
Funding for this research was provided by Amgen Inc., Thousand Oaks, CA
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Oster, G., Lamerato, L., Glass, A.G. et al. Use of intravenous bisphosphonates in patients with breast, lung, or prostate cancer and metastases to bone: a 15-year study in two large US health systems. Support Care Cancer 22, 1363–1373 (2014). https://doi.org/10.1007/s00520-013-2094-y
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DOI: https://doi.org/10.1007/s00520-013-2094-y