Multiple Myeloma and Bone Metastases: Dosing Interval of Bone-Modifying Agents
Posted: Monday, October 1, 2018
In a clinical review published in the Journal of Oncology Practice, Erica Campagnaro, MD, Associate Professor of Hematology, Internal Medicine, and Medical Oncology, Michigan Medicine Hematology Clinic, Rogel Cancer Center at the University of Michigan, and colleagues discussed how new data on dosing of bone-modifying agents influence the treatment of multiple myeloma. Recent findings demonstrate that when using zoledronic acid to reduce the risk of skeletal-related events in patients with multiple myeloma as well as metastatic breast cancer and metastatic prostate cancer, the dosing interval of zoledronic acid may be extended from every 4 weeks to every 12 weeks.
Earlier this year, the American Society of Clinical Oncology published new guidelines for using bone-modifying agents in this patient population. They state that any patient who receives treatment for active multiple myeloma should receive bisphosphonate therapy. The benefit of this recommendation is to decrease skeletal complications in those who have osteoporosis but no lytic disease.
In terms of the duration of zoledronic acid therapy, Dr. Campagnaro and colleagues noted that previous studies suggest a potential benefit with continued dosing beyond 2 years, although this has not been evaluated in a randomized study. Data from the single-arm Z-MARK study suggested that less-frequent dosing of zoledronic acid may be associated with a low incidence of skeletal-related events.
“The 12-week zoledronic acid dosing interval seems to be clinically accepted for multiple myeloma,” concluded the clinical reviewers. “Presently there is insufficient evidence to support alternative dosing intervals of denosumab.”