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CECOG experts’ recommendations on the use of denosumab in the prevention of skeletal-related events in bone metastases of lung cancer

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Abstract

Purpose

Skeletal-related events represent a substantial burden for patients with advanced cancer. Randomized, controlled studies suggested superiority of denosumab over zoledronic acid in the prevention of skeletal-related events in metastatic cancer patients, with a favorable safety profile. Experts gathered at the 2012 Skeletal Care Academy in Istanbul to bring forward practical recommendations, based on current evidence, for the use of denosumab in patients with bone metastases of lung cancer.

Recommendations

Based on current evidence, use of denosumab in lung cancer patients with confirmed bone metastases is recommended. It is important to note that clinical judgment should take into consideration the patient’s general performance status, overall prognosis, and live expectancy. Currently, the adverse event profile reported for denosumab includes hypocalcemia and infrequent occurrence of osteonecrosis of the jaw. Therefore, routine calcium and vitamin D supplementation, along with dental examination prior to denosumab initiation are recommended. There is no evidence for renal function impairment due to denosumab administration. At present, there is no rationale to discourage concomitant use of denosumab and surgery or radiotherapy.

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Abbreviations

BMA:

Bone modifying agent

CI:

Confidence interval

CRBD:

Cancer-related bone disease

CT:

Computed tomography

EBRT:

External beam radiation therapy

EGFR m+:

Epidermal growth factor receptor (EGFR) mutation positive

EML4 ALK:

Characteristic abnormal configuration of DNA, where the echinoderm microtubuleassociated protein-like 4 (EML4) gene is fused to the anaplastic lymphoma kinase (ALK) gene

EMA:

European Medicines Agency

ESMO:

European Society for Medical Oncology

EU:

European Union

FDA:

Food and Drug Administration

HCM:

Hypercalcemia of malignancy

HR:

Hazard ratio

MRI:

Magnetic resonance imaging

NSCLC:

Non-small cell lung cancer

ONJ:

Osteonecrosis of the jaw

Q4W:

Once every 4 weeks

RANKL:

Receptor activator of nuclear factor κB ligand

SBRT:

Stereotactic body radiotherapy

SCA:

Skeletal Care Academy

SCLC:

Small cell lung cancer

SRE:

Skeletal-related event

US:

United States of America

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Conflict of interest

LT has received an honorarium from Central European Cooperative Oncology Group for the attendance of an advisory board.

WH had received an honorarium from Amgen for the attendance of an advisory board.

EKW received an honorarium from Central European Cooperative Oncology Group (CECOG) for the attendance of an advisory board and honoraria from Amgen.

All others declare no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Internal Medicine (Hematology and Oncology), Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria

    Wolfgang Hilbe MD

  2. Radiation Oncology, Neolife Medical Center, Istanbul, Turkey

    Ufuk Abacioglu MD

  3. Universitätsklinik für Radio-Onkologie, Inselspital, Bern, Schweiz

    Daniel M. Aebersold MD

  4. Centre d’Oncologie 16 Novembre, Rabat, Morocco

    Mounir Bachouchi MD

  5. Clinical Division of Oncology and Department of Medicine I, Comprehensive Cancer Center, Medical University Vienna, General Hospital, Vienna, Austria

    Thomas Brodowicz MD

  6. Medical Oncology Department, National Cancer Institute (NCI), Cairo University, Cairo, Egypt

    Rabab Gaafar MD

  7. Department of Orthopedics, Medical University Vienna, General Hospital, Vienna, Austria

    Gerold Holzer MD

  8. 2. Int. Abt. Sozialmedizinisches Zentrum, Otto-Wagner-Spital, Vienna, Austria

    Andrea Mohn-Staudner MD

  9. Medical Oncology Clinic, Multiprofile Hospital for Active Treatment, Varna, Bulgaria

    Dimitar Kalev MD

  10. Regional Cancer Center, Lodz, Poland

    Ewa Kalinka-Warzocha MD

  11. Institute of Oncology Ljubljana, Ljubljana, Slovenia

    Viljem Kovac MD

  12. Cantonal Hospital, St. Gallen, Switzerland

    Marco Siano MD

  13. Department of Medical Oncology, Marmara University Hospital Breast Center, Istanbul, Turkey

    Fulden Yumuk MD

  14. Department of Pulmonology, Semmelweis University, Dios arok 1/c, 1125, Budapest, Hungary

    Lilla Tamasi MD

Authors
  1. Wolfgang Hilbe MD
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  2. Ufuk Abacioglu MD
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  3. Daniel M. Aebersold MD
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  6. Rabab Gaafar MD
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  7. Gerold Holzer MD
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  8. Andrea Mohn-Staudner MD
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  9. Dimitar Kalev MD
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  10. Ewa Kalinka-Warzocha MD
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  11. Viljem Kovac MD
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  12. Marco Siano MD
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  13. Fulden Yumuk MD
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  14. Lilla Tamasi MD
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Corresponding author

Correspondence to Lilla Tamasi MD.

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Hilbe, W., Abacioglu, U., Aebersold, D. et al. CECOG experts’ recommendations on the use of denosumab in the prevention of skeletal-related events in bone metastases of lung cancer. memo 6, 75–82 (2013). https://doi.org/10.1007/s12254-013-0088-6

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  • DOI: https://doi.org/10.1007/s12254-013-0088-6

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