Department of Medicine, Division of Medical Oncology, The Ottawa Hospital and the University of Ottawa, 501 Smyth Road, Ottawa, Canada.
Cancer Therapeutics Program, Ottawa Hospital Research, and University of Ottawa, Ottawa, Canada.
Breast Cancer Res Treat. 2021 Jun;187(2):477-486. doi: 10.1007/s10549-021-06147-1. Epub 2021 Mar 23.
Despite the increasing use of adjuvant bone-modifying agents (BMAs) such as zoledronate and clodronate in the treatment of patients with early stage breast cancer (EBC), little is known about real world practice patterns. A physician survey was performed to address this deficit and determine interest in clinical trials of alternative strategies for BMA administration.
Canadian oncologists treating patients with EBC were surveyed via an anonymized online survey. The survey collected information on: physician demographics, knowledge and interpretation of adjuvant bisphosphonate guidelines, and real world prescribing practices. Questions also determined thoughts around the design of future adjuvant BMA trials.
Of 127 surveyed physicians, 53 eligible invitees responded (response rate 42%). The majority of physicians are offering high-risk postmenopausal patients adjuvant BMAs. The most common BMA regimen was adjuvant zoledronate (45/53, 85%) every 6 months for 3 years. Concerns around toxicities and repeated visits to the cancer centre were perceived as the greatest barriers to adjuvant bisphosphonate use. Respondents were interested in future trials of de-escalation of BMAs comparing a single infusion of zoledronate vs. 6-monthly zoledronate for 3 years. The most favoured primary endpoints for such a trial included disease recurrence and fragility fracture rates.
Questions around optimal use of adjuvant bisphosphonates in patients with EBC still exist. There is interest among physicians in performing trials of de-escalation of these agents. The results of this survey will assist in designing pragmatic clinical trials to address this question.
尽管在治疗早期乳腺癌（EBC）患者时越来越多地使用唑来膦酸和氯膦酸等辅助骨修饰剂（BMA），但对于实际的治疗模式却知之甚少。进行了一项医生调查，以解决这一不足，并确定对替代 BMA 给药策略临床试验的兴趣。
通过匿名在线调查对治疗 EBC 的加拿大肿瘤学家进行了调查。该调查收集了有关：医生人口统计学，对辅助双膦酸盐指南的了解和解释以及实际处方实践的信息。问题还确定了对未来辅助 BMA 试验设计的想法。
在接受调查的 127 名医生中，有 53 名合格的受邀者做出了回应（回应率为 42％）。大多数医生为高风险绝经后患者提供辅助 BMA。最常见的 BMA 方案是每 6 个月使用辅助唑来膦酸（45/53，85％），持续 3 年。毒性和反复去癌症中心就诊被认为是使用辅助双膦酸盐的最大障碍。受访者对未来的 BMA 降级试验感兴趣，这些试验比较了唑来膦酸单次输注与 3 年 6 个月的唑来膦酸的比较。此类试验的首选主要终点包括疾病复发和脆性骨折发生率。
关于 EBC 患者辅助双膦酸盐最佳使用的问题仍然存在。医生对这些药物的降级试验感兴趣。这项调查的结果将有助于设计实用的临床试验来解决这一问题。
