Ruth O'Regan, MD (pictured at upper right), professor and head, and Amye Tevaarwerk, MD (pictured at lower right), associate professor (CHS), both of Hematology, Medical Oncology and Palliative Care, have co-authored an opinion article for oncology professionals about the use of adjuvant bisphosphonates. 

This is a class of drugs commonly prescribed to treat osteoporosis. The routine use of adjuvant bisphosphonates to decrease the risk of breast cancer bone metastases and other recurrence has been a topic of discussion in the medical oncology community. 

Oncologists have grappled with whether or not to routinely recommend bisphosphonates, explain Dr. O'Regan and Dr. Tevaarwerk. 

That uncertainty remains in the face of a recent clinical practice guideline that is based on post-hoc analyses of primary trials, they say. 

The guideline, which was recently issued by a joint expert panel comprised of Cancer Care Ontario and the American Society of Clinical Oncology (ASCO), applies to all postmenopausal women with stage I to III breast cancer who are otherwise candidates for adjuvant systemic therapy.

Drs. O'Regan and Tevaarwerk express concern that this broad category includes some patients who would actually be at low risk for recurrence based on their individual health status (such as whether they are postmenopausal at time of diagnosis or rendered postmenopausal due to treatment for cancer) and genetics.  

"We applaud the efforts of the expert panel to direct us to some standardization with respect to practice surrounding adjuvant bisphosphonates. The guideline will serve to remind oncologists to consider adjuvant bisphosphonates. However, it is unlikely to help busy clinicians and patients parse out the nuanced potential benefits and may contribute to an 'all-or-nothing' approach," write Drs. O'Regan and Tevaarwerk. 

Resources:

• "One Size May Not Fit All: Thoughts on the New Adjuvant Bisphosphonate Guideline for Early-Stage Breast Cancer," ASCO Post, August 10, 2017