Trends in the use of bone agents in metastatic cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e20672-e20672
Author(s):  
Jurgen Wilhelm Kogler ◽  
William J. Hrushesky ◽  
Dinah Huff ◽  
Laura Rose Bobolts ◽  
Akhil Kumar ◽  
...  
Keyword(s):  
Single Dose ◽  
Zoledronic Acid ◽  
Linear Regression ◽  
Cancer Patients ◽  
Metastatic Cancer ◽  
Chi Square ◽  
Frequency Of Use ◽  
Skeletal Related Events ◽  
Care Costs ◽  
Over Time

e20672 Background: Bone modifying agents have been shown to delay and/or prevent skeletal-related events for a range of cancers metastatic to the bone. Various studies have identified pamidronate, zoledronic acid, and denosumab as bone modifying agents, each of which confers clinical benefit. The convenience of administration and costs of these agents differ greatly. Administration spans vary from roughly 2 hours for IV pamidronate, 15 minutes for IV zoledronic acid, and minimal time for subcutaneous denosumab. The estimated cost for a single dose of pamidronate, zoledronic acid, and denosumab are $29, $890, and $1,712, respectively. Methods: All requests for pamidronate, zoledronic acid, and denosumab authorization submitted by practicing oncologists within southeast Florida were tabulated for 2010, 2011, and 2012. Comparisons for both frequency of use and cost over time were made using ANOVA and Chi Square; p<0.05 for significance. Trends were assessed by linear regression. Results: 895 requests for pamidronate, zoledronic acid, or denosumab were examined over this three year span. The use of bone modifying agents for metastatic cancer is increasing rapidly, as treatment request totaled 171, 269, and 455 for all three agents, pamidronate, zoledronic acid, or denosumab, in 2010, 2011, and 2012, respectively. Zoledronic acid requests significantly increased (p<0.001) per year between 2010 and 2011, as with 2011 and 2012. Denosumab requests are also increasing steadily and sharply in 2012. Conclusions: Each of these three agents has demonstrated clear efficacy in delaying or preventing second skeletal events among patients with metastatic cancer already involving bone. Toxicities among these three agents are comparable in the vast majority of eligible cancer patients. Relative costs should be carefully considered when choosing which agent to use as the use of these agents in general is increasing rapidly and will have a major impact upon overall cancer care costs. [Table: see text]

Zoledronic acid effect on circulating RANK/RANK-l/OPG axis in cancer patients.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 10615-10615
Author(s):  
Toni Ibrahim ◽  
Laura Mercatali ◽  
Marianna Ricci ◽  
Emanuela Scarpi ◽  
Francesca Fabbri ◽  
...  
Keyword(s):  
Zoledronic Acid ◽  
Bone Metastases ◽  
Objective Response ◽  
Case Series ◽  
Roc Curve Analysis ◽  
Acid Effect ◽  
Bone Response ◽  
Circulating Markers ◽  
Skeletal Related Events ◽  
Over Time

10615 Background: Bone metastasis disrupts bone integrity through loss of the balance between osteoclastic-mediated osteolysis and osteoblastic osteogenesis. The RANK/RANK-L/OPG axis governs osteoclastogenesis and bone resorption. We evaluated the trend of markers over time. Secondary aims were to study the predictive role of different circulating markers in the response to Zoledronic Acid (ZA) with respect to objective response and to skeletal-related events (SREs). Methods: The study prospectively evaluated levels of RANK, RANKL and OPG transcripts by Real-Time PCR and VEGF and NTX expression by ELISA in the peripheral blood of 49 consecutive patients with advanced breast, prostate or lung cancer (36, 7 and 6, respectively). Enrolled patients were at first diagnosis of bone metastases and had not previously undergone treatment with bisphosphonates. Patients received the standard schedule of ZA (4 mg infusion every 28 days) for about 12 months, undergoing blood tests and instrumental evaluation before the first infusion of ZA and every 4 months thereafter. Results: Median RANKL values after 12 infusions of ZA had decreased by 22% with respect to baseline whereas OPG, had increased by about 96%, with a 56% decrease in the RANKL/OPG ratio. NTX decreased over time (p<0.0001). On the basis of ROC curve analysis, RANKL was the most accurate marker for bone response with an AUC of 0.74 (95% CI 0.54-0.93). No correlations were found between circulating markers and SREs. Conclusions: The present work is one of the few prospective studies carried out on the circulating markers that are potentially associated with bone metastases. Our findings would seem to indicate that ZA decreases osteoclast activity through RANK/RANKL/OPG pathway modulation and that RANKL may play a role in the prediction of objective response to ZA. Confirmation of results is needed in a larger case series.

Trends of skeletal related events in patients with breast cancer metastasized to bone.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 1098-1098
Author(s):  
Prasanth Lingamaneni ◽  
Ishaan Vohra ◽  
Krishna Rekha Moturi ◽  
Muhammad Zain Farooq ◽  
Sheeba Habeeb Ba Aqeel ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Health Care ◽  
Cancer Patients ◽  
Surgical Intervention ◽  
Temporal Trends ◽  
Multivariable Analysis ◽  
Breast Cancer Patients ◽  
Inpatient Mortality ◽  
Skeletal Related Events ◽  
Over Time

1098 Background: Up to three-quarters of women with advanced breast cancer develop bone metastases, predisposing to Skeletal Related Events (SRE), which are associated with a significant health care burden, poor prognosis, loss of functional independence and a decrease in quality of life. We performed a retrospective analysis on predictors of SRE in this population. We also evaluated temporal trends of outcomes and resource utilization in those with SRE. Methods: Adult breast cancer patients with metastases to bone, admitted from January 2012 to September 2015 were identified from the Nationwide Inpatient Sample database. Based on previous studies, SRE was defined by using ICD-9 codes for pathologic fracture, spinal cord compression, necessity for radiation to bone or surgery to bone. Multivariable analysis of predictors of SRE in patients with breast cancer metastatic to bone, as well as mortality in the SRE group were performed. Temporal trends of resource utilization across the years were evaluated. Results: A total of 143,455 patients with breast cancer with metastases to bone were identified, of which 17.2% had SRE. Patients with SRE had a mean age of 66 years and were predominantly white (70.2%). After adjusting for confounders, African Americans and Hispanics were less likely than Whites to develop SRE. On multivariable analysis, only comorbidity burden (in the form of high Charlson comorbidity index) predicted inpatient mortality. Rates of SRE in breast cancer patients with bone metastases did not change over the years (17.2% to 17.1%). Inpatient mortality of patients with SRE remained stable (3.76% to 3.79%). There was a statistically significant increase in surgical intervention (43.4% to 47.7%, p<0.01) and decrease in radiation to bone (25.7% to 19.7%, p<0.001) over time. Length of hospital stay and total hospital charges, after adjusting for inflation, remained largely unchanged. Conclusions: Incidence of SRE, inpatient outcomes and health care costs remained stagnant in those with metastatic breast cancer between 2012 and 2015, despite the advent of novel bone-targeted agents. There has been an increased trend towards surgical intervention and less utilization of local radiation over time. [Table: see text]

Practice patterns in bone modifying agent utilization: An analysis in patients with metastatic cancer and bone involvement at an NCI-designated center.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 62-62
Author(s):  
Poorni Manohar ◽  
Kyle Bastys ◽  
Micah Tratt ◽  
Julie Gralow ◽  
Keith D. Eaton
Keyword(s):  
Breast Cancer ◽  
Cancer Care ◽  
Practice Patterns ◽  
Metastatic Cancer ◽  
Metastatic Breast ◽  
Bone Involvement ◽  
Prescribing Patterns ◽  
Fiscal Year ◽  
Skeletal Related Events ◽  
Over Time

62 Background: Bone modifying agents (BMA) can reduce skeletal related events for patients with metastatic cancer and bone involvement. ASCO supports use of Zoledronic acid (ZA) and Denosumab (DB), with specific endorsement of both an every 3 to 4-week (Q1 month) and every 12-week (Q3 month) schedule for ZA in metastatic breast cancer. Trends in BMA utilization may identify areas to improve value in cancer care. Methods: We retrospectively reviewed utilization of BMAs at Seattle Cancer Care Alliance/University of Washington from fiscal year 2015-2019. We identified 1,286 patients who underwent 12,594 administrations. Data was categorized by BMA (ZA acid vs DB) and disease group. A 45-day cutoff defined interval of treatment (Q1 vs Q3). Whole-sale acquisition cost (WAC) and administration costs were estimated from CMS allowed charges. We calculated total costs spent during time period and projected potential savings for switching from Q1 to Q3 ZA administration. Results: A total of 904 patients received ZA (7201 administrations) and 473 patients received DB (5,393 administrations). The breast, myeloma, prostate, and kidney groups accounted for 81% of administrations. In breast, 427 patients received ZA (1,761 administrations) and 411 patients received DB (2,708 administrations). Among all patients, DM and ZA administrations remained constant over time, however, in breast, there was a trend towards less DB and more ZA administrations. The administration frequency (Q1 vs Q3) for both drugs stayed constant in the total cohort. Among ZA administrations in breast, there was a reversal in the trend for Q1 vs Q3, with Q1 being most common in 2015, and Q3 the most common in 2019 (crossover in 2018 fiscal year). In breast, 30 patients transitioned from Q1 to Q3, with majority occurring before 2017 ASCO update. Total costs on BMA utilization was estimated as $11,672,189,80, 90% attributable to DB. The projected savings for switching from Q1 to Q3 ZA administration was $1,223,961.08. Conclusions: BMA prescribing patterns from 2015-2019 show no change in ZA and DB utilization, though a trend towards increased ZA and decreased DB use in breast cancer was observed. There was a transition in practice patterns to adopt the Q3 ZA administration over time, however, the uptake of this has been incomplete. It is hoped that raising awareness of these practice patterns will lead to adoption of guideline-based decision making and promote value-based cancer care.

Renal function among cancer patients with bone metastases treated with zoledronic acid in a real world setting

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 19540-19540 ◽  
Author(s):  
B. L. Nordstrom ◽  
C. Langer ◽  
A. Hussain ◽  
V. Barghout ◽  
D. Modi ◽  
...  
Keyword(s):  
Renal Function ◽  
Zoledronic Acid ◽  
Bone Metastases ◽  
Cancer Patients ◽  
Subsequent Treatment ◽  
Community Based ◽  
Skeletal Related Events ◽  
Treatment Changes ◽  
Baseline Levels

19540 Background: Zoledronic acid (ZA) is a bisphosphonate that reduces skeletal related events (SREs) in cancer patients (pts) with bone metastases but can impact renal function in some pts. This retrospective study examined serum creatinine (sCr) elevations and subsequent treatment changes among pts receiving ZA in community based medical practices. Methods: Data were obtained from the Varian Medical Oncology database of electronic medical records from 17 US oncology practices. Cancer pts with bone metastases and at least one ZA infusion in 2002–06 were followed; all available sCr levels were examined. SCr measurements ≤4 weeks after a ZA infusion were considered levels while on ZA. Elevated sCr was defined as an increase over baseline of ≥0.5 mg/dL or a doubling from baseline for pts with baseline levels <1.4 mg/dL (or ≥1.0 mg/dL for higher baseline levels). Pts with a sCr elevation on ZA were followed to observe changes in ZA dosing and sCr. Results: The study included 875 pts (318 with breast cancer, 131 lung, 154 prostate, 23 multiple myeloma, and 249 other or unknown cancer) with ≥1 sCr level during baseline and ≥1 (median 6) while on ZA. Median age was 66, 41% were male, and 90% had baseline sCr under 1.4 mg/dL. Pts received a median of 6 ZA infusions. SCr elevations occurred in 87 pts (10%), at a median of 19 weeks (range 0.6–126) after the start of ZA. Pts with baseline sCr over 2.0 mg/dL were more likely to experience an elevation (11 pts, 33%). Following the elevated sCr, 37 pts (43%) discontinued ZA; dose reductions and delays were infrequent. Among 49 pts who remained on ZA after elevated sCr and had further sCr while on ZA, 20 (41%) returned to within 10% of baseline, at a median of 7 weeks (range 0.3–31) after the first measured elevation. The proportion returning to normal is a conservative estimate given limited follow-up sCr data. Conclusions: The observed incidence of elevated sCr of 10% in this community based study is similar to clinical trials. Most pts either discontinued ZA or returned to baseline levels despite continued ZA treatment. Few practitioners adhered to recommendations to withhold ZA until levels return to within 10% of baseline. No significant financial relationships to disclose.

Arrhythmias during and after zoledronic acid infusion patients with bone metastasis.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e20614-e20614
Author(s):  
Ozan Yazici ◽  
Sercan Aksoy ◽  
Ozgul Ucar ◽  
Nuriye Özdemir ◽  
Mevlut Demir ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Zoledronic Acid ◽  
Cancer Patients ◽  
Metastatic Cancer ◽  
Demographic Data ◽  
Acid Infusion ◽  
Increased Risk ◽  
History Of ◽  
Infusion Period

e20614 Background: Zoledronic acid (ZA) is one of the important biphosphanate which is widely used in bone metastatic cancer patients and osteoporotic patients. In a few studies it has been reported that treatment with biphosphonate was associated with an increased risk for atrial fibrillation. We aim to evaluate the arrhythmias that developed during infusion and immediately after infusion of the ZA. Methods: Bone metastatic 52 patients were included in study group. All of patients had totally 24 hour holter motorization during the first dose ZA infusion day. All of patients had 4 hours basal cardiac rhythm records before ZA infusion and about 19 hours after infusion. A short survey including demographic data and past medical history was completed. None of patients had clinically important arrhythmias before ZA infusion. We divided arrhythmias as supraventricular and ventricular. We evaluated arrhythmias pre, during and after ZA infusion. ZA were administered 4 mg IV in 15 minutes. Results: Thirty three of patients (63,5%) were male and 19 (36,5%) female. Median age of the patients was 52 (27-73). Most frequent cancers were breast (25%) and lung cancer (15,3%).Twelve (23%) patients had history of mediastinal radiotherapy. Three patients had history of myocardial infarction. In basal records we detected that twenty four of patients had supraventricular tachycardia (SVT) or ventricular premature systole (VPS). Fifteen of patients had SVT and fourteen had VPS during infusion period. After infusion period 48 of patients had SVT and 41 had VPS. Only 3 patients had none of arrhythmia after infusion. Three of the patients had sinusoidal arrhythmia and two had Mobitz type 2 bloc after infusion and also one of our patient who had no history of co morbidities and had SVT basal records, developed atrial fibrillation that refractory to medical cardioversion after 10 days of seventh dose ZA infusion. Conclusions: In this study we found that both SVT and VPS increased in cancer patients treated with ZA. Furthermore ZA may induce clinically important arrhythmias.

Zoledronic acid and skeletal-related events in patients with bone metastatic cancer or multiple myeloma

2019 ◽  
Vol 38 (2) ◽  
pp. 254-263 ◽  
Author(s):  
Ha-Lim Jeon ◽  
In-Sun Oh ◽  
Yeon-Hee Baek ◽  
Hyowon Yang ◽  
Jeehye Park ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Zoledronic Acid ◽  
Metastatic Cancer ◽  
Skeletal Related Events
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