Benefit of adjuvant bisphosphonates in early breast cancer treated with contemporary systemic therapy: A meta-analysis of randomized control trials.

Autor:	Mittal A; North East Cancer Centre, Health Sciences North, Northern Ontario School of Medicine (NOSM U), Sudbury, ON, Canada.; Princess Margaret Cancer Centre, Division of Medical Oncology, Toronto, ON, Canada.; University of Toronto, Department of Medicine, Toronto, ON, Canada., Tamimi F; Princess Margaret Cancer Centre, Division of Medical Oncology, Toronto, ON, Canada.; University of Toronto, Department of Medicine, Toronto, ON, Canada., Molto C; Princess Margaret Cancer Centre, Division of Medical Oncology, Toronto, ON, Canada.; University of Toronto, Department of Medicine, Toronto, ON, Canada., Di Iorio M; Princess Margaret Cancer Centre, Division of Medical Oncology, Toronto, ON, Canada.; University of Toronto, Department of Medicine, Toronto, ON, Canada., Amir E; Princess Margaret Cancer Centre, Division of Medical Oncology, Toronto, ON, Canada.; University of Toronto, Department of Medicine, Toronto, ON, Canada.
Jazyk:	angličtina
Zdroj:	Heliyon [Heliyon] 2024 Jan 19; Vol. 10 (2), pp. e24793. Date of Electronic Publication: 2024 Jan 19 (Print Publication: 2024).
DOI:	10.1016/j.heliyon.2024.e24793
Abstrakt:	Background: The absolute and relative benefits of adjuvant bisphosphonates on disease-free survival and overall survival in patients receiving contemporary systemic therapy for early breast cancer is uncertain. Methods: Data from randomized trials of adjuvant bisphosphonates that recruited patients exclusively after 2000 and reported disease free survival and overall survival was utilized. Five-year disease-free survival and overall survival in bisphosphonates and control group along with associated hazard ratios were extracted. Absolute data were weighted by sample size and hazard ratios were pooled using inverse variance and random effects modelling. Meta-regression comprising linear regression weighted by sample size (mixed effects) was performed to explore association between disease and treatment related factors and absolute differences in benefit from bisphosphonates. Results: Eleven trials comprising 24023 patients were included in the analysis. For disease free survival, pooled hazard ratio was 0.89 (0.81-0.97, p = 0.008) with a 1.5 % weighted mean difference favoring bisphosphonates over control. There was no significant overall survival benefit (0.92, 0.82-1.03, p = 0.16). Among patients receiving anthracycline and taxane based chemotherapy, there were no differences in either disease free survival (0.95, 0.80-1.12) or overall survival (1.04, 0.81-1.32). Meta-regression showed lower benefits in higher risk patients (node-positive, larger tumor size, estrogen receptor-, grade 3 or those receiving chemotherapy). Overall, 1 % (95 % CI 0.75-1.15) of patients experienced osteonecrosis of jaw related to zoledronic acid. Conclusions: Compared to the Early Breast Cancer Trialist's Collaborative Group meta-analysis, benefit from adjuvant bisphosphonates is lower in recent trials especially in higher risk patients receiving contemporary chemotherapy. The balance between benefits and risks of adjuvant bisphosphonates should be considered in individual patients. Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. (© 2024 The Authors. Published by Elsevier Ltd.)
Databáze:	MEDLINE
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