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Efficacy and safety of de-escalation bone- modifying agents for cancer patients with bone metastases: a systematic review and meta-analysis

BACKGROUND: Compared with application of bone-modifying agents (BMAs) every 4 weeks, it is unclear whether 12-weekly de-escalated therapy can be used as a substitute strategy. METHODS: A systematic search of PubMed, EMBASE, and the Cochrane Register of Controlled Trials until November 22, 2017, was...

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Autores principales: Liu, Cun, Wang, Lu, Liu, Lijuan, Zhuang, Jing, Tang, Shifeng, Zhang, Tiansong, Zhou, Chao, Feng, Fubin, Liu, Ruijuan, Zhang, Jinmei, Zhang, Tingting, Gao, Chundi, Li, Huayao, Li, Jia, Sun, Changgang
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove Medical Press 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6159799/
https://www.ncbi.nlm.nih.gov/pubmed/30288112
http://dx.doi.org/10.2147/CMAR.S176811
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author Liu, Cun
Wang, Lu
Liu, Lijuan
Zhuang, Jing
Tang, Shifeng
Zhang, Tiansong
Zhou, Chao
Feng, Fubin
Liu, Ruijuan
Zhang, Jinmei
Zhang, Tingting
Gao, Chundi
Li, Huayao
Li, Jia
Sun, Changgang
author_facet Liu, Cun
Wang, Lu
Liu, Lijuan
Zhuang, Jing
Tang, Shifeng
Zhang, Tiansong
Zhou, Chao
Feng, Fubin
Liu, Ruijuan
Zhang, Jinmei
Zhang, Tingting
Gao, Chundi
Li, Huayao
Li, Jia
Sun, Changgang
author_sort Liu, Cun
collection PubMed
description BACKGROUND: Compared with application of bone-modifying agents (BMAs) every 4 weeks, it is unclear whether 12-weekly de-escalated therapy can be used as a substitute strategy. METHODS: A systematic search of PubMed, EMBASE, and the Cochrane Register of Controlled Trials until November 22, 2017, was performed. Randomized controlled trials (RCTs) were included to assess skeletal-related event (SRE) rates, adverse events, and bone turnover biomarkers, comparing 12-weekly de-escalated treatments with standard 4-weekly dosage regimens. Risk ratios (RRs) with 95% CIs were pooled in fixed-effect meta-analyses. RESULTS: A total of eight citations were eligible comprising 2,878 patients: zoledronate (three studies, 2,650 patients), pamidronate (two studies, 68 patients), and denosumab (three studies, 160 patients). Summary RR (0.98; 95% CI 0.87–1.12; P=0.82) for SRE rates between de-escalated and standard arms was produced when seven low risk of bias trials (695 patients) were pooled, and results without statistical significance also appeared in the analysis of adverse events and bone turnover biomarkers. Due to the limited sample size and methodological differences, the data for skeletal morbidity rates (SMRs), time to first SRE, serum C-telopeptide (sCTx) levels, and hypocalcemia were not combined, but systematic review still obtained similar indistinguishableness. CONCLUSION: In this meta-analysis of randomized clinical trials, the results “appeared” to show non-inferiority of the 12-weekly treatment. Due to the difference in available data, the results for bisphosphonates are more solid than for the receptor activator of nuclear factor-κB ligand (RANKL) antibodies.
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spelling pubmed-61597992018-10-04 Efficacy and safety of de-escalation bone- modifying agents for cancer patients with bone metastases: a systematic review and meta-analysis Liu, Cun Wang, Lu Liu, Lijuan Zhuang, Jing Tang, Shifeng Zhang, Tiansong Zhou, Chao Feng, Fubin Liu, Ruijuan Zhang, Jinmei Zhang, Tingting Gao, Chundi Li, Huayao Li, Jia Sun, Changgang Cancer Manag Res Original Research BACKGROUND: Compared with application of bone-modifying agents (BMAs) every 4 weeks, it is unclear whether 12-weekly de-escalated therapy can be used as a substitute strategy. METHODS: A systematic search of PubMed, EMBASE, and the Cochrane Register of Controlled Trials until November 22, 2017, was performed. Randomized controlled trials (RCTs) were included to assess skeletal-related event (SRE) rates, adverse events, and bone turnover biomarkers, comparing 12-weekly de-escalated treatments with standard 4-weekly dosage regimens. Risk ratios (RRs) with 95% CIs were pooled in fixed-effect meta-analyses. RESULTS: A total of eight citations were eligible comprising 2,878 patients: zoledronate (three studies, 2,650 patients), pamidronate (two studies, 68 patients), and denosumab (three studies, 160 patients). Summary RR (0.98; 95% CI 0.87–1.12; P=0.82) for SRE rates between de-escalated and standard arms was produced when seven low risk of bias trials (695 patients) were pooled, and results without statistical significance also appeared in the analysis of adverse events and bone turnover biomarkers. Due to the limited sample size and methodological differences, the data for skeletal morbidity rates (SMRs), time to first SRE, serum C-telopeptide (sCTx) levels, and hypocalcemia were not combined, but systematic review still obtained similar indistinguishableness. CONCLUSION: In this meta-analysis of randomized clinical trials, the results “appeared” to show non-inferiority of the 12-weekly treatment. Due to the difference in available data, the results for bisphosphonates are more solid than for the receptor activator of nuclear factor-κB ligand (RANKL) antibodies. Dove Medical Press 2018-09-21 /pmc/articles/PMC6159799/ /pubmed/30288112 http://dx.doi.org/10.2147/CMAR.S176811 Text en © 2018 Liu et al. This work is published and licensed by Dove Medical Press Limited The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.
spellingShingle Original Research
Liu, Cun
Wang, Lu
Liu, Lijuan
Zhuang, Jing
Tang, Shifeng
Zhang, Tiansong
Zhou, Chao
Feng, Fubin
Liu, Ruijuan
Zhang, Jinmei
Zhang, Tingting
Gao, Chundi
Li, Huayao
Li, Jia
Sun, Changgang
Efficacy and safety of de-escalation bone- modifying agents for cancer patients with bone metastases: a systematic review and meta-analysis
title Efficacy and safety of de-escalation bone- modifying agents for cancer patients with bone metastases: a systematic review and meta-analysis
title_full Efficacy and safety of de-escalation bone- modifying agents for cancer patients with bone metastases: a systematic review and meta-analysis
title_fullStr Efficacy and safety of de-escalation bone- modifying agents for cancer patients with bone metastases: a systematic review and meta-analysis
title_full_unstemmed Efficacy and safety of de-escalation bone- modifying agents for cancer patients with bone metastases: a systematic review and meta-analysis
title_short Efficacy and safety of de-escalation bone- modifying agents for cancer patients with bone metastases: a systematic review and meta-analysis
title_sort efficacy and safety of de-escalation bone- modifying agents for cancer patients with bone metastases: a systematic review and meta-analysis
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6159799/
https://www.ncbi.nlm.nih.gov/pubmed/30288112
http://dx.doi.org/10.2147/CMAR.S176811
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