Elsevier

Journal of Bone Oncology

Volume 18, October 2019, 100252
Journal of Bone Oncology

Review Article
Denosumab for bone health in prostate and breast cancer patients receiving endocrine therapy? A systematic review and a meta-analysis of randomized trials

https://doi.org/10.1016/j.jbo.2019.100252Get rights and content
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Highlights

  • Hormonal receptors positive breast tumor and prostate cancer are managed with endocrine therapies.

  • Endocrine therapies designed for breast and prostate cancer are often associated to serious adverse skeletal related events, such fractures.

  • Denosumab is a monoclonal anti-body binding RANKL which acts as inhibitor of osteoclasts activity, thus increasing bone mass.

  • Denosumab was showed to strongly prevent hormonal therapies-related skeletal issues.

  • Denosumab administration results safe in bone mass increase and reduction of fractures risk.

Abstract

Hormonal therapies for receptor positive-breast and prostate cancer patients have shown clinical efficacy but also several side effects including osteoporosis, loss of bone mass and increased fracture risk. Denosumab represents an anti RANKL (receptor activator of nuclear factor-kB ligand) monoclonal anti-body acting as inhibitor of osteoclasts formation, function, and survival, then increasing bone mass. Herein, we performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the role of Denosumab in saving bone health in prostate and breast cancer patients receiving respectively androgen deprivation therapy and adjuvant endocrine therapy. Moreover, selected patients have to be treated with Denosumab at the dose of 60 mg every six month or placebo. Outcomes studied included the bone mass density (BMD) increase at 24 and 36 months, BMD loss, reduction of fractures risk (in particular vertebral) at 24 and 36 months and safety (overall, serious adverse events – SAEs and discontinuation rate). Our results showed a reduction of the BMD loss up to 36 months both at the lumbar and femoral level and a BMD increase both at 24 and 36 months. It was also found a reduction in the number of new vertebral and femoral fractures at 24 and 36 months. Finally, our pooled analysis showed that Denosumab did not affect both the SAEs and therapy discontinuation risk. In conclusion, Denosumab administration can be considered effective and safe in the prevention and management of the above mentioned adverse events related to hormonal therapies designed for breast and prostate tumors.

Keywords

Breast
Prostate
Cancer
Hormone
Denosumab
Fracture

Abbreviations

ADT
androgen deprivation therapy
BMD
bone mass density
CI
confidence interval
HR
hazard ratio
MD
mean difference
RANKL
receptor activator of nuclear factor-kB ligand
RCTs
randomized clinical trials
SAEs
serious adverse events

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1

These authors contributed equally to this work.