Medical School, Memorial University, Newfoundland, Newfoundland and Labrador, Canada.
Support Care Cancer. 2013 Jun;21(6):1557-60. doi: 10.1007/s00520-012-1694-2. Epub 2013 Jan 19.
Bone metastases occur in 65-75% of patients with metastatic breast cancer. These patients are at risk of developing skeletal-related events (SREs). SREs are defined as any pathological fracture, spinal cord compression, hypercalcemia, and surgery or radiation required for treatment of bone metastases. Bisphosphonates are used to prevent the development of SREs. The purpose of this study is to review the incidence of SREs in metastatic breast cancer patients with bony disease in Newfoundland and Labrador and to determine if there is an association between SREs and the type of bisphosphonate therapy given.
This retrospective chart review includes all metastatic breast cancer patients with bony disease treated at the Dr. H. Bliss Murphy Cancer Centre from 2008 to 2010. Patient demographics, treatment received, and treatment changes were collected. Patients at the Centre received bisphosphonate, pamidronate or zolendronic acid to prevent SREs. The prescribing pattern of bisphosphonates was collected. The occurrences of SREs were then compared to the type of treatment received.
Sixty-five patients with breast cancer and bony metastasis were identified using the provincial tumor registry, three patients were excluded from the review as their charts could not be located. Following the initial diagnosis of bone metastasis, 8 patients (12.7%) were started on zolendronic acid, 50 patients (80.6%) were started on pamidronate, and 4 (6.4%) received no treatment. Six patients (75%) on zolendronic acid experienced one SRE; however, none experienced multiple SREs. Thirty-one patients (62%) on pamidronate experienced one SRE, and ten (20%) had multiple SREs. Of the 31 patients on pamidronate with an SRE, 4 (12.9%) were switched to zolendronic acid. Three of the four (75%) had multiple SREs despite treatment changes. Of the six patients on zolendronic acid with SREs, none were switched to pamidronate.
Our results show that the majority of patients with breast cancer, who develop bony metastases in Newfoundland and Labrador, are initially treated with the bisphosphonate, pamidronate. Over 60% of these patients experienced at least one SRE, and 20% had more than two SREs. A small proportion of the patients were initially started on zolendronic acid, and this group had better outcomes with fewer SREs and none had more than two SREs. It appears that zolendronic acid is superior to pamidronate in preventing SREs; however, zolendronic acid is being used primarily as second-line in Newfoundland and Labrador.
在转移性乳腺癌患者中，有 65%-75%发生骨转移。这些患者有发生骨骼相关事件（SREs）的风险。SREs 定义为任何病理性骨折、脊髓压迫、高钙血症，以及为治疗骨转移而进行的手术或放疗。双膦酸盐用于预防 SREs 的发生。本研究的目的是回顾纽芬兰和拉布拉多省有骨疾病的转移性乳腺癌患者中 SREs 的发生率，并确定 SREs 是否与所给予的双膦酸盐治疗类型有关。
这项回顾性图表审查包括 2008 年至 2010 年在 H. Bliss Murphy 癌症中心接受治疗的所有转移性乳腺癌伴骨疾病患者。收集了患者的人口统计学数据、治疗方法和治疗方法的变化。该中心的患者接受双膦酸盐、帕米膦酸或唑来膦酸治疗以预防 SREs。收集了双膦酸盐的处方模式。然后将 SREs 的发生情况与所接受的治疗进行比较。
使用省级肿瘤登记处确定了 65 名患有乳腺癌和骨转移的患者，由于无法找到其病历，有 3 名患者被排除在审查之外。在最初诊断为骨转移后，8 名患者（12.7%）开始使用唑来膦酸，50 名患者（80.6%）开始使用帕米膦酸，4 名患者（6.4%）未接受治疗。在使用唑来膦酸的 6 名患者中，有 75%出现 1 次 SRE，但没有出现多次 SRE。在使用帕米膦酸的 31 名患者中，有 62%出现 1 次 SRE，有 20%出现多次 SRE。在出现 SRE 的 31 名使用帕米膦酸的患者中，有 12.9%的患者改用唑来膦酸。这 4 名患者中有 3 名（75%）尽管进行了治疗改变，但仍出现多次 SRE。在出现 SRE 的 6 名使用唑来膦酸的患者中，没有患者改用帕米膦酸。
我们的结果表明，在纽芬兰和拉布拉多省，大多数发生骨转移的乳腺癌患者最初接受的是双膦酸盐帕米膦酸治疗。这些患者中有超过 60%至少出现了 1 次 SRE，有 20%出现了 2 次以上的 SRE。少数患者最初使用唑来膦酸，该组 SRE 发生率较低，无患者出现 2 次以上 SRE。唑来膦酸似乎优于帕米膦酸，能更好地预防 SREs；然而，唑来膦酸在纽芬兰和拉布拉多主要作为二线药物使用。
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