Rounds with the Investigators 2012 | Breast Cancer

QUESTION: Is it time yet to add a bisphosphonate to aromatase inhibitors routinely for early-stage ER-positive postmenopausal breast cancer in the adjuvant setting?

DR NEIL LOVE: So, Sara, a question from a physician at the University of Arkansas for Medical Sciences, Dr Gadgil: Is it time yet to add a bisphosphonate to aromatase inhibitors routinely for early ER-positive, postmenopausal breast cancer? We saw a little more data on that. I’m starting to think people are getting tired of hearing about it. We saw some stuff on that at ASCO. What’s the bottom line in your practice right now?

DR SARA HURVITZ: I’m not using it routinely. I am having a discussion in the higher-risk patients, lymph node-positive, ER-positive and firmly postmenopausal. I was quite disappointed by the AZURE data and the fact that it didn’t really seem to support ZOFAST and ABCSG-12. I think there is a lot more to be learned, and there’s a risk-benefit ratio that has to be considered because bisphosphonates are not without risks and toxicities. And if you have a patient who’s potentially been cured by surgery and radiation and maybe endocrine therapy and chemo, and you’re giving them a bisphosphonate when they are cured, they may be deriving all the toxicity risks to the kidney, risk for ONJ, risk of hypocalcemia.

We participated in the “D-CARE” study, which is about to close, looking at denosumab in the adjuvant setting. And that’s where I have preferred putting on my higher-risk patients, which is looking at all comers; HER2-positive, HER2-negative, lymph node-positive — mainly lymph node-positive Stage II breast cancer, using denosumab in the adjuvant setting for 5 years.

But the other problem with interpreting these studies is they all have different regimens that are being used. Some are 5 years of therapy. They have different frequencies of the zoledronic acid being given. So it’s another long discussion in the clinic setting, but I’m not using it often. I have maybe 1 patient on it.