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Real-world practice patterns and attitudes towards de-escalation of bone-modifying agents in patients with bone metastases from breast and prostate cancer: A physician survey
- Source :
- Journal of Bone Oncology, Journal of Bone Oncology, Vol 26, Iss, Pp 100339-(2021)
- Publication Year :
- 2020
-
Abstract
- Highlights • Questions around optimal use of bone-modifying agents (BMAs) still exist. • Most physicians are de-escalating BMAs in patients with metastatic breast cancer. • Practice varies according to patient insurance coverage. • There is interest performing further trials of de-escalation especially after 2 years of treatment.<br />Background There remain questions around the optimal use of bone-modifying agents (BMAs) in patients with bone metastases from breast and castration-resistant prostate cancer (CRPC). A physician survey was performed to identify current practices, as well as perceptions around long-term BMA use, BMA de-escalation, and further BMA de-escalation after 2 years of use. Methods Canadian oncologists treating breast cancer or CRPC were surveyed via an anonymized online survey. The survey collected physician demographics, current practice patterns, perception on risk of symptomatic skeletal events (SSE) and BMA-associated toxicities, and attitudes towards further de-escalation of BMAs after 2 years of treatment. Results A total of 334 physicians in Canada were contacted, of which 295 were eligible on initial screening, and 65 completed the survey (response rate 22%): 35 treated breast cancer, 25 treated prostate cancer and 5 treated both. The most common BMA regimens in patients with no limitation in drug coverage were denosumab q4wks for 3–4 months followed by a de-escalation to q12wks (breast cancer) and denosumab q4wks (prostate cancer). In patients with provincial health coverage only the common choices were zoledronate q4wks for 3–4 months followed by de-escalation to q12wks (breast cancer) and denosumab q4wks (prostate cancer). There was equipoise regarding the benefit of continuing BMA beyond 2 years and interest in further trials of de-escalation of BMA in both breast and prostate cancer. The most favored alternative primary study endpoints to SSE were BMA toxicity (67.2%), pain (46.9%), and physical function (48.4%). Conclusion Despite their extensive use and costs, questions around optimal use of BMAs still exist. Practice varies according to patient insurance coverage. However, most physicians are de-escalating BMAs. There is interest amongst clinicians in performing trials of de-escalation, especially after 2 years of treatment.
- Subjects :
- 0301 basic medicine
Oncology
medicine.medical_specialty
lcsh:Diseases of the musculoskeletal system
Pamidronate
lcsh:RC254-282
03 medical and health sciences
Prostate cancer
0302 clinical medicine
Breast cancer
Internal medicine
Clinical endpoint
Medicine
In patient
Survey
Response rate (survey)
business.industry
Bone metastasis
Bone modifying agent
medicine.disease
lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens
030104 developmental biology
Denosumab
030220 oncology & carcinogenesis
lcsh:RC925-935
business
De-escalation
medicine.drug
Research Article
Zoledronate
Subjects
Details
- ISSN :
- 22121366
- Volume :
- 26
- Database :
- OpenAIRE
- Journal :
- Journal of bone oncology
- Accession number :
- edsair.doi.dedup.....81b5b503e2ce6f9dfa15723efd80db9b