Approach for Advanced Cancer Patients with Bone Metastases by the Bone Metastasis Board: A Single-institution Retrospective Study

Prevention, early diagnosis, and early treatment of skeletal-related events (SREs) are important in the treatment of potential or current cases of bone metastasis. In August 2020, our hospital established the bone metastasis team and the bone metastasis board (BMB) started actively engaging in activities aimed at improving the outcome of bone metastasis. We retrospectively examined whether a combined modality therapy started in the diagnosis of bone metastases could prevent the onset of SREs and whether it could prolong survival and improve activities of daily living. The 75 advanced cancer patients who underwent BMB at our hospital from August 1, 2020 to July 31, 2022 were divided into two groups according to when BMB performed before and after SREs for comparative analysis. Numerical Rating Scale improved, however Performance Status did not improve in both groups, and there was no difference in survival between the both groups (15.3 vs. 9.0 months, HR: 0.74, 95%; CI: 0.42–1.29, p=0.29). In conclusion, patients who suffered from SREs from the time of bone metastasis diagnosis were treated early. However, the incidence of SREs after BMB in our hospital was 22.6%, and it is necessary to actively work to prevent SREs in the future.

Impacto econômico da adoção de denosumabe em pacientes com metástases ósseas ou mieloma múltiplo sob a perspectiva do sistema de saúde privado brasileiro / Economic impact of denosumab adoption in cancer patients with bone metastases or multiple myeloma from the Brazilian private healthcare system's perspective

Objetivo: Estimar o custo por evento relacionado ao esqueleto (ERE) e o impacto econômico anual da adoção de denosumabe em pacientes com metástases ósseas secundárias ao câncer de mama, próstata e outros tumores sólidos ou mieloma múltiplo sob a perspectiva do sistema de saúde privado brasileiro. Métodos: Um modelo econômico foi desenvolvido para comparar os custos relacionados com denosumabe versus ácido zoledrônico na prevenção de EREs. O modelo incluiu os seguintes custos: medicamento, administração, monitoramento e manejo de ERE. O custo anual foi apresentado em reais (BRL) para 100 pacientes. Os custos do manejo de ERE [fratura vertebral (FV), fratura não vertebral (FNV), radiação óssea (RO), cirurgia óssea (CO) e compressão da medula espinhal (CME)] foram estimados a partir dos recursos e procedimentos coletados da revisão de literatura, bases de dados e painel Delphi. Dados coletados dos estudos clínicos randomizados relacionados com cada tipo de tumor na análise e de um estudo prospectivo observacional foram utilizados para estimar a eficácia clínica de denosumabe versus ácido zoledrônico. Resultados: O custo por cada tipo de ERE variou de BRL 27.246 a BRL 28.035 para FV, BRL 18.023 a BRL 18.811 para FNV, BRL 42.750 a BRL 43.538 para RO, BRL 18.023 a BRL 18.811 para CO e BRL 12.472 a BRL 13.260 para CME. A introdução de denosumabe foi estimada em economia anual por 100 pacientes de até BRL 1.072.043,14 para câncer de mama, BRL 1.212.822,79 para outros tumores sólidos, BRL 1.929.660,67 para câncer de próstata e BRL 77.965,07 para mieloma múltiplo. Conclusão: Esta análise sugere que EREs adicionam custos substanciais no manejo de pacientes com metástases ósseas. Dessa forma, o uso de denosumabe pode prevenir e retardar EREs em pacientes com câncer e pode possivelmente levar à redução do impacto econômico associado aos EREs sob a perspectiva dos pagadores de saúde privada brasileira.

Objective: To estimate the cost per SRE and annual economic impact of denosumab adoption in patients with bone metastases (BM) secondary to breast cancer, prostate cancer, other solid tumors or multiple myeloma from the Brazilian private healthcare system's perspective. Methods: An economic model was developed to compare the cost outcomes associated with denosumab instead of zoledronic acid for SRE prevention. The model included the following costs: drug, administration, monitoring and SRE management. Annual costs per 100 patients were reported in 2019 Brazilian currency (BRL). The SRE management costs (vertebral fracture (VF), non-vertebral fracture (NVF), radiation to bone (RB), surgery to bone (SB) and spinal cord compression (SCC)) were estimated from the resources and procedures collected from literature review, official database, and a Delphi panel. Data collected from randomized clinical trials related to each tumor type in the analysis and from a prospective observational study was used to estimate the clinical efficacy of denosumab vs zoledronic acid. Results: The cost per each type of SREs across all tumors ranged BRL 27,246 ­ BRL 28,035 for VF, BRL 18,023 ­ BRL 18,811 for NVF, BRL 42,750 ­ BRL 43,538 for RB, BRL 18,023 ­ BRL 18,811 for SB and BRL 12,472 ­ BRL 13,260 for SCC. The introduction of denosumab was estimated to result in annual savings per 100 patients of up to BRL 1,072,043.14 for breast cancer, BRL 1,212,822.79 for other solid tumors, BRL 1,929,660.67 for prostate cancer and BRL 77,965.07 for multiple myeloma. Conclusion: This analysis suggests that SREs add substantial costs to the management of patients with bone metastases. In this way, the use of denosumab would prevent and delay SREs in cancer patients and might possibly lead to reduce the economic burden associated with SREs, borne by Brazilian private healthcare payers.

Medical therapy of bone metastases of breast cancer / 国际肿瘤学杂志

Approximately 70％ advanced breast cancer will develop bone metastases.Bone metastases can cause a series of complications such as skeletal-related events,seriously affecting the quality of life of the patients.Therefore,it is very important to choose the reasonable and effective treatments.Bisphosphonates are the standard treatments of bone metastatic breast cancer,denosumab may also be a reasonable alternative to bisphosphonates in the near future,while chemotherapy,endocrinotherapy and targeted therapy are the basic treatments of advanced breast cancer,combined use of various treatments will get the best efficacy.

Comparative study on the efficacy and safety of zoledronic acid and sodium ibandronate in treating bone metastasis in breast cancer patients / 中华内分泌外科杂志

ObjectiveTo retrospectively evaluate the efficacy and safety of zoledronic acid and sodium ibandronate in treating bone metastasis in breast cancer patients.MethodsThe study included 47 patients who were treated with zoledronic acid and sodium ibandronate respectively from Aug.2006 to Mar.2011. KaplanMeier curve and Log rank test were adopted to detect the difference in survival time of skeletal related event (SRE) and survival rate between patients treated with different medicine,and x2 test was uscd to rcveal thc rate difference of pain killing effects and adverse effects.Results 1.The total effective rate of pain killing was 88.9％ and 85％ respectively.The difference had no statistical significance(P =0.467).2.The 1,2 and 3-year-survival rate in zoledronic acid group and sodium ibandronate group was 88.7％,44.4％,24.2％vs 94.7％,40.5％,5.8％.The difference had no statistical significance(P =0.744).3.The 2,3,and 4-year-survival rate in zoledronic acid group and sodium ibandronate group was 70.4％,40.7％,23.1％ vs 85％,46.7％,17.5％.The difference had no statistical significance( P =0.994).4.The 1,2 and 3-year SRE-free overall survival rate of the group with metastasis first to bone only was 92％,50.8％,and 23.8％,while the rate of the group with first metastasis to visceral organs was 85.4％,21.4％,and 5.3％ ( P =0.012).5.The 2 and 3-year overall survival rate of the group with metastasis first to bone only was 95.8％ and 74.2％ respectively,while the rate of the group with first metastasis to visceral organs was 56.5％ and 10.1％ ( P ＜0.001 ).The difference of 4 and 5 had statistical significance.The difference of zoledronic acid group and sodium ibandronate group in rate of adverse effects had no statistical significance.Conclusions Compared to sodium ibandronate,zoledronic acid has no superiority in either delaying the occurrence of SRE or improving overall survival rate.The -2are similar in incidence of adverse effects and pain control.The prognosis of patients whose first presentation is complicated by metastasis to other organs is poor.