Bone-Modifying Agents for the Treatment and Prevention of Skeletal-Related Events (SRE) and Hypercalcemia

Compiled for you by PharmaWrite

Presented by Jennifer Davis, PharmD, BCOP
Community Health Network, Indianapolis, IN

Key Takeaways

• Although there are no formal guidelines for the treatment of hypercalcemia of malignancy, hydration along with bisphosphonates are the backbone of therapy
• Osteoclast inhibitors are recommended for all patients with bone metastases
• More data on the duration of therapy for SREs are needed since it is unclear if therapy should be continued for at least 12-24 months or indefinitely.
• Several guidelines and references are available to assist with decision-making, including ASCO, ESMO, and NCCN

This session focused on the role of denosumab in the treatment of hypercalcemia of malignancy (HCM) and the role for using bisphosphonates for the prevention of skeletal-related events (SREs). Although there are no formal guidelines for the definition and treatment of hypercalcemia, management takes into account both corrected calcium and severity of symptoms. Hydration and intravenous bisphosphonates remain the initial treatment of choice, with zoledronic acid achieving faster normalization of serum calcium and shorter time to hypercalcemia relapse versus pamidronate. Denosumab has been approved by the FDA for hypercalcemia that is refractory to bisphosphonates.

Information was also presented on the prevention and treatment of SREs associated with bone metastasis. The ASCO breast cancer (bone metastasis) guidelines (Van Poznak 2011), the European Society of Medical Oncology guidelines (Coleman 2014), and the NCCN prostate cancer (bone metastasis) guidelines were reviewed. Considerations for the selection of an osteoclast inhibitor is dependent on several factors, such as the disease state and efficacy data, route of administration, frequency, renal function, safety profile, and drug costs. Denosumab is the preferred agent for many cancer types (except multiple myeloma). The speaker concluded that more data, specifically on the duration of therapy, are still needed since it is unclear if therapy should be continued for at least 12-24 months or indefinitely.

This session summary was prepared by Ginah Nightingale, PharmD, BCOP, a member of the PharmaWrite Oncology Working Group.

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