We did not identify any literature with the purpose of determining the efficacy of BMAs in reducing femur fractures or other skeletal related events specifically among patients with metastatic carcinoma or myeloma lesions involving the femur. However, there are studies among patients with metastatic carcinoma or myeloma bone lesions not explicitly localized to the femur (Fizazi, 2009; Hortobagyi, 2017; Raje 2016/18; Lipton 2000/12; Morgan 2011/13; Stopeck, 2010, Martin 2012) demonstrating reduction in skeletal related events with use of BMAs.
Due to the observed benefit in these studies of improved clinical outcomes in context of the acceptable safety profile of commonly used BMAs, it is our consensus that treatment with BMAs in patients with metastatic carcinoma or myeloma involving the femur is advised.
Future research should specifically assess outcomes of femur fractures in patients with metastatic carcinoma or myeloma treated with BMAs.
- Fizazi, K., Lipton, A., Mariette, X., Body, J. J., Rahim, Y., Gralow, J. R., Gao, G., Wu, L., Sohn, W., Jun, S. Randomized phase II trial of denosumab in patients with bone metastases from prostate cancer, breast cancer, or other neoplasms after intravenous bisphosphonates. Journal of Clinical Oncology 2009; 10: 1564-71
- Hortobagyi, G. N., Van Poznak, C., Harker, W. G., Gradishar, W. J., Chew, H., Dakhil, S. R., Haley, B. B., Sauter, N., Mohanlal, R., Zheng, M., Lipton, A. Continued Treatment Effect of Zoledronic Acid Dosing Every 12 vs 4 Weeks in Women With Breast Cancer Metastatic to Bone: The OPTIMIZE-2 Randomized Clinical Trial. JAMA Oncol 2017; 7: 906-912
- Raje, N., Terpos, E., Willenbacher, W., Shimizu, K., Garcia-Sanz, R., Durie, B., Legiec, W., Krejci, M., Laribi, K., Zhu, L., Cheng, P., Warner, D., Roodman, G. D. Denosumab versus zoledronic acid in bone disease treatment of newly diagnosed multiple myeloma: an international, double-blind, double-dummy, randomised, controlled, phase 3 study. Lancet Oncology 2018; 3: 370-381
- Raje, N., Vescio, R., Montgomery, C. W., Badros, A., Munshi, N., Orlowski, R., Hadala, J. T., Warsi, G., Argonza-Aviles, E., Ericson, S. G., Anderson, K. C. Bone Marker- Directed Dosing of Zoledronic Acid for the Prevention of Skeletal Complications in Patients with Multiple Mye oma: Results of the Z-MARK Study. Clinical Cancer Research 2016; 6: 1378-84
- Lipton, A., Theriault, R. L., Hortobagyi, G. N., Simeone, J., Knight, R. D., Mellars, K., Reitsma, D. J., Heffernan, M., Seaman, J. J. Pamidronate prevents skeletal complications and is effective palliative treatment in women with breast carcinoma and osteolytic bone metastases: long term follow-up of two randomized, placebo-controlled trials. Cancer 2000; 5: 1082-90
- Lipton, A., Fizazi, K., Stopeck, A. T., Henry, D. H., Brown, J. E., Yardley, D. A., Richardson, G. E., Siena, S., Maroto, P., Clemens, M., Bilynskyy, B., Charu, V., Beuzeboc, P., Rader, M., Viniegra, M., Saad, F., Ke, C., Braun, A., Jun, S. Superiority of denosumab to zoledronic acid for prevention of skeletal-related events: a combined analysis f 3 pivotal, randomised, phase 3 trials. European Journal of Cancer 2012; 16: 3082-92
- Morgan, G. J., Child, J. A., Gregory, W. M., Szubert, A. J., Et al., National Cancer Research Institute Haematological Oncology Clinical Studies, Group Effects of zoledronic acid versus clodronic acid on skeletal morbidity in patients with newly diagnosed multiple myeloma (MRC Myeloma IX): secondary outcomes from a randomised controlled trial. Lancet Oncology 2011; 8: 743-52
- Morgan, G. J., Davies, F. E., Gregory, W. M., Bell, S. E., Szubert, A. J., Cook, G., Drayson, M. T., Owen, R. G., Ross, F. M., Jackson, G. H., Child, J. A. Long-term follow- up of MRC Myeloma IX trial: Survival outcomes with bisphosphonate and thalidomide treatment. Clinical Cancer Research 2013; 21: 6030-6038
- Stopeck, A.T., Lipton, A., Body, J.J., Steger, G.G., Tonokin, K., De Boer, R.H., et. al. 2010. Denosumab compared with zoledronic acid for the treatment of bone metastases in patients with advanced breast cancer: a randomized, double-blind study. J Clin Oncol. 28(35):5132-9
- Martin, M., Bell, R., Brufsky, A., Diel, I., Eniu, A., Fallowfield, L., et. al. 2012. Bone- related complications and quality of life in advanced breast cancer: results from a randomized phase III trial of denosumab versus zoledronic acid. Clin Cancer Res. 18(17): 4841-9