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Recommendations for antiresorptive therapy in postmenopausal patients with breast cancer: Marburg AIBL Guideline Evaluation Study (MAGES)

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Abstract

Postmenopausal women with hormone-receptor-positive breast cancer usually receive aromatase inhibitor (AI) therapy at some point in their disease management. Accelerated bone loss during AI therapy poses a problem, especially in postmenopausal women who may already have age-related osteopenia or several fracture-related risk factors. Guidelines and algorithms have been developed to identify women at risk for fractures from low bone mineral density and to provide recommendations for antiresorptive treatment. However, the factors used to calculate fracture risk and the thresholds for antiresorptive treatment vary among the current guidelines and algorithms, potentially leading to inconsistent recommendations for or against antiresorptive treatment. The present study analyzed antiresorptive treatment decisions in a population of postmenopausal women with hormone-receptor-positive breast cancer receiving AI therapy using five different guidelines/algorithms (World Health Organization Fracture Risk Assessment tool [FRAX], expert consensus, German Dachverband Osteologie, American Society of Clinical Oncology, and World Health Organization). The consistency of a recommendation for antiresorptive treatment among the five methods was low (4 %). The consistency of a recommendation against antiresorptive treatment among the five methods was higher (57 %), but left approximately 40 % of patients with an inconsistent recommendation. The consequences of overtreatment (unnecessary exposure to adverse events) and undertreatment (increased risk of fractures and possibly decreased disease-free survival) make it imperative that the existing guidelines and algorithms be improved. Moreover, evidence-based outcomes from antiresorptive treatment decisions are required to validate guidelines and algorithms.

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Abbreviations

AI:

Aromatase inhibitor

AIBL:

Aromatase inhibitor-associated bone loss

ASCO:

American Society of Clinical Oncology

BMD:

Bone mineral density

BMI:

Body mass index

DVO:

Dachverband Osteologie

ER:

Estrogen receptor

FRAX:

WHO Fracture Risk Assessment tool

HER2:

Human epidermal growth receptor 2

NOGG:

National Osteoporosis Guideline Group

SERM:

Selective estrogen receptor modulator

WHO:

World Health Organization

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Acknowledgments

We thank Tamalette Loh, PhD., at ProEd Communications, Inc., for her medical editorial assistance. Funding for medical editorial assistance was provided by Novartis Pharmaceuticals Corporation.

Conflict of interest

Dr. Hadji has received honoraria, unrestricted educational grants, and research funding from the following companies: Amgen, AstraZeneca, GlaxoSmithKline, Eli Lilly, Novartis, Pfizer, and Roche. Ms. Hartenfels and Drs. Kyvernitakis, Hars, Baumann, and Kalder have no conflicts to disclose.

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Correspondence to Peyman Hadji.

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Hadji, P., Hartenfels, M., Kyvernitakis, J. et al. Recommendations for antiresorptive therapy in postmenopausal patients with breast cancer: Marburg AIBL Guideline Evaluation Study (MAGES). Breast Cancer Res Treat 133, 1089–1096 (2012). https://doi.org/10.1007/s10549-012-2023-7

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