Osteoclast inhibitors for patients with bone metastases from solid tumors*

CRPC: castration-resistant prostate cancer; SRE: skeletal-related event.
* Osteoclast inhibitors are indicated for management of metastatic bone disease for most patients with solid tumors. For patients in whom SREs are unlikely (eg, those with minimal bone tumor burden) and for those with a limited expected survival (eg, those with extensive and progressive visceral metastases), treatment with osteoclast inhibitors should be considered on a case-by-case basis.
¶ Where available, pamidronate, clodronate, and ibandronate are potential alternatives to zoledronic acid for patients with breast cancer. Data on the use of ibandronate and clodronate for other solid tumors are limited, making these less favored options.
Δ There are no prospective data from randomized trials to support extrapolation of an extended dosing interval (ie, every 12 weeks) to non-breast, non-CRPC solid tumors for either denosumab or bisphosphonates. However, there may be circumstances (eg, no rapid bone resorption, limited bone disease) where an extended dosing interval fits the goals of care. Continue treatment indefinitely.
◊ Modification of the dosing intervals for long-term bisphosphonate therapy should be directed by the risk of SREs, the potential for treatment-related toxicities, and the goals of care. The data supporting the switch from monthly to every-3-month dosing for zoledronic acid are limited to breast cancer.