Dystrophic Cutaneous Calcification and Metaplastic Bone Formation due to Long Term Bisphosphonate Use in Breast Cancer

Bisphosphonates are widely used in the treatment of breast cancer with bone metastases. We report a case of a female with breast cancer presented with a rash around a previous mastectomy site and a discharge lesion on her right chest wall in August 2010. Biopsy of the lesion showed dystrophic calcification and metaplastic bone formation. The patient’s history revealed a long term use of zoledronic acid for the treatment of breast cancer with bone metastasis. We stopped the treatment since we believed that the cutaneous dystrophic calcification could be associated with her long term bisphosphonate therapy. Adverse cutaneous events with bisphosphonates are very rare, and dystrophic calcification has not been reported previously. The dystrophic calcification and metaplastic bone formation in this patient are thought to be due to long term bisphosphonate usage.

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Bisphosphonate-induced osteonecrosis of the jaw: Incidence and risk factors in patients with breast cancer and gynecological malignancies

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.1113 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 1113-1113

Author(s):

V. Beck ◽

E. Solomayer ◽

M. Krimmel ◽

C. Reinert ◽

T. Fehm

Keyword(s):

Breast Cancer ◽

Risk Factors ◽

Zoledronic Acid ◽

Bone Metastases ◽

Osteonecrosis Of The Jaw ◽

Bisphosphonate Therapy ◽

Gynecological Malignancies ◽

Dental Procedures ◽

The Mean ◽

Number Of Treatment

1113 Background: Bisphosphonates are potent inhibitors of osteoclast-mediated bone resorption. They are successfully used in conditions of increased bone turnover such as osteoporosis or bone metastases. Since 2003 multiple cases of bisphosphonate-induced osteonecrosis of the jaw (ONJ) were reported. Our purpose was to describe the incidence and risk factors of ONJ in patients with breast cancer or gynecological malignancies. Patients and Methods: ONJ was assessed retrospectively for all patients with breast cancer or gynecological malignancies treated with bisphosphonates at the Department of Gynecology and Obstetrics, University Hospital Tuebingen during April 1999 until May 2006. Results: 10 of 310 (3%) patients with breast cancer or gynecological malignancies developed ONJ while receiving bisphosphonate therapy. All patients with ONJ were treated for bone metastases. Except one all patients with ONJ had a history of recent dental procedures. All patients had received zoledronic acid as part of their bisphosphonate regimen. In 4 of 10 patients this was the only bisphosphonate given. The remaining 6 patients had received at least one of the other bisphosphonates (alendronate, ibandronate, clodronate or pamidronate) before or after zoledronic acid therapy during their course of disease. Time of exposure to bisphosphonates and the number of treatment cycles were significant risk factors for the development of ONJ (p<0.001). In patients diagnosed with ONJ the mean number of treatment cycles was 27 ±18 cycles (median: 21 cycles, range 6–62 cycles) and the mean duration of bisphosphonate therapy was 29 ±20 months (median: 22 months, range 1–67 months). In contrast, the mean number of treatment cycles in patients without manifestation of ONJ was 11 ±12 cycles (median: 6 cycles, range 1–90 cycles). The mean duration of therapy was 12 months (median: 7 months, range 1–81 months). Conclusion: Osteonecrosis of the jaw is regarded a major side effect of bisphosphonate therapy. Length of exposure to bisphosphonates and the number of treatment cycles seem to be the most important risk factors for the development of ONJ. In addition, recent dental procedures favours the development of an ONJ. No significant financial relationships to disclose.

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Renal safety of zoledronic acid administration beyond 24 months in breast cancer patients with bone metastases

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.19669 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 19669-19669

Author(s):

M. K. Altundag ◽

M. Dincer ◽

H. Harputluoglu ◽

S. Aksoy ◽

Y. Ozisik ◽

...

Keyword(s):

Breast Cancer ◽

Zoledronic Acid ◽

Bone Metastases ◽

Cancer Patients ◽

Breast Cancer Patients ◽

Skeletal Complications ◽

Few Data ◽

Acid Administration ◽

Renal Safety

19669 Background: Zoledronic acid (ZA) delays the onset or reduces the incidence of skeletal complications in breast cancer patients with bone metastases. However there are few data on the long-term renal safety of ZA. Methods: We retrospectively evaluated 43 breast cancer patients with bone metastases who received ZA more than 24 months. The following parameters measured prior to first ZA use and after the last dose of ZA administration were compared: serum creatinine (SCr), blood urea nitrogen (BUN), alkaline phosphatase (ALP), calcium (Ca), and phosphorous (P). Results: Forty-three breast cancer patients with documented bone metastases were evaluated. Median age at the start of treatment was 53 years (range, 37 to 77). Median overall duration of ZA administration was 36 months (25 to 62). There were no statistically significant differences in the pre- and post-treatment levels of SCr, BUN, Ca and P. However, ALP levels after long-term ZA administration were decreased significantly (P <0.05). Conclusion: More than 24 months of ZA administration did not adversely affect the renal function. ZA can be used safely in breast cancer patients with bone metastases beyond 2 years. [Table: see text] No significant financial relationships to disclose.

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PO72 CLINICAL SAFETY AND EFFICACY OF LONG-TERM USE OF ZOLEDRONIC ACID HYDRATE FOR BREAST CANCER BONE METASTASIS

The Breast ◽

10.1016/s0960-9776(13)70086-9 ◽

2013 ◽

Vol 22 ◽

pp. S44-S45

Author(s):

Tomofumi Osako ◽

Reiki Nishimura ◽

Yasuyuki Nishiyama ◽

Rumiko Tashima ◽

Masahiro Nakano ◽

...

Keyword(s):

Breast Cancer ◽

Zoledronic Acid ◽

Bone Metastasis ◽

Clinical Safety ◽

Safety And Efficacy ◽

Acid Hydrate ◽

Breast Cancer Bone Metastasis

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Safety and Efficacy of Long-Term Zoledronic Acid in Advanced Breast Cancer with Bone Metastasis in South China

Journal of Oncology ◽

10.1155/2020/5670601 ◽

2020 ◽

Vol 2020 ◽

pp. 1-10

Author(s):

Qianyu Wang ◽

Guifang Guo ◽

Zhaohui Ruan ◽

Huijiao Cao ◽

Ying Guo ◽

...

Keyword(s):

Breast Cancer ◽

Zoledronic Acid ◽

Bone Metastasis ◽

Advanced Breast Cancer ◽

Hearing Impairment ◽

Advanced Breast ◽

Short Term ◽

Short Term Treatment ◽

Cox Regression Analysis

Background. This retrospective study aimed to characterize the long-term (>24 months) safety profile of zoledronic acid (ZA). We aimed to investigate whether long-term ZA treatment had greater benefits than short-term treatment in patients from southern China with advanced breast cancer (ABC) with bone metastasis. Patients and Methods. A total of 566 metastatic breast cancer cases were included and divided into two groups according to the duration of ZA treatment. The included patients had at least one lytic bone lesion and had no skeletal-related events (SREs) prior to ZA therapy. The primary endpoint was to analyze the safety and long-term adverse effects, which covered osteonecrosis of jaws (ONJ), renal impairment, and hearing impairment. The second objective was to determine the efficacy of long-term ZA treatment by the incidence of SREs. Results. Fifteen patients were diagnosed with ONJ (2.7%): nine in the short-term group (3.1%) and six in the long-term group (2.2%, P = 0.606). Five cases (0.9%) had renal function impairment: two in the short-term group (0.7%) and four in the long-term group (1.1%, P = 0.676). One patient (0.2%) in the long-term group had hearing impairment after 23 months of ZA treatment (0.4%, P = 0.482). In total, 103 cases in the short-term group (35.2%) and 138 cases in long-term group (50.5%) developed SREs (P < 0.001). The mean annual SRE rate was 0.3 in the short-term group (range, 0–3.1) versus 0.2 in the long-term group (0–1.0, P = 0.269). Subgroup analysis suggested that cases with non-load-bearing bone involvement and those who received systematic anticancer therapy without chemotherapy might benefit from long-term ZA treatment. Cox regression analysis indicated poor performance status, and nonvisceral organ involvement predicted high risk for SRE. Conclusions. The extension of ZA treatment did not increase the long-term adverse events and reduced the annual incidence of SREs beyond 24 months. Although longer treatment of ZA over 24 months appeared to be safe, further prospective investigation is required.

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