ASCO and CCO update metastatic breast cancer guidelines

Paul Basilio, MDLinx | November 07, 2017

The American Society of Clinical Oncology (ASCO), in collaboration with Cancer Care Ontario (CCO), recently published a clinical practice guideline about the role of bone-modifying agents (BMAs) in postmenopausal patients with metastatic breast cancer.


The potential benefits and harms and the mechanisms of action should be considered when planning long-term BMA use.

Key updates include:

  • Postmenopausal patients with breast cancer and evidence of metastasis to bone should receive BMAs (eg, denosumab, pamidronate, or zoledronic acid).
  • There is insufficient evidence of a clinically meaningful benefit for the use of one BMA over another. The ASCO Expert Panel stated that further clinical research is needed for this topic.
    • Patients prescribed zoledronic acid should receive 4 mg IV over at least 15 minutes. Dosing options include every 12 weeks or every 3 to 4 weeks.
    • BMAs should not be used alone for bone pain, as their analgesic effect is modest.
      • The Panel recommended that the current standard of care for supportive care and pain management be applied. This includes adjunct therapies, radiotherapy, surgery, analgesia, systemic anticancer therapy, and referrals for pain management or other supportive care.

Previous recommendations from the 2011 guidelines that remain unchanged include:

  • The potential benefits and harms and the mechanisms of action should be considered when planning long-term BMA use.
  • In patients with creatinine clearance >60 mL/min, creatinine level should be monitored with each IV bisphosphonate dose, but no change in dosage, infusion time, or interval is required.
  • In patients with creatinine clearance
  • All patients should undergo a dental examination and preventive dentistry prior to initiation of BMAs.

“The ASCO bone-modulating agent [BMA] guideline update advances patient care by identifying an effective regimen of zoledronic acid that is less intensive than the prior standard,” said Catherine Van Poznak, MD, Panel co-chair. “The BMA update includes the most recent data on how these drugs may provide a modest analgesic effect and reinforces the recommendation that bone pain is to be treated using the current standard of care for pain and symptom management.”

Dr. Van Poznak emphasized that the ASCO-CCO BMA Panel does not recommend one BMA over another, and that additional research is needed to further understand the optimal use of the drugs.

For more information about these guidelines, click here