Clinical Practice Update on Bone-Modifying Agents in Patients With Multiple Myeloma
A team of researchers from the American Society of Clinical Oncology (ASCO) released an updated clinical practice guideline on the role of bone-modifying agents in patients with multiple myeloma. The findings, published in the Journal of Clinical Oncology by Kenneth Anderson, MD, PhD, of the Dana-Farber Cancer Institute, Boston, and colleagues, recommend intravenous administration of pamidronate or zoledronic acid for patients with active symptomatic multiple myeloma. Those recommendations are regardless of evidence of lytic bone destruction or spine compression fracture from osteopenia on plain radiograph(s) or other imaging studies.
Dr. Anderson and colleagues conducted a targeted systematic literature review, ultimately using 35 relevant studies to form the basis of the updated guideline. The researchers suggest the administration of 90 mg of pamidronate over at least 2 hours or 4 mg of zoledronic acid over at least 15 minutes every 3 to 4 weeks for those with active symptomatic myeloma.
Other recommendations focus on the duration of bone-modifying treatment. The update panel suggests such treatment should continue for up to 2 years. However, in patients with responsive or stable disease, less frequent dosing may be considered.
For the prevention of skeletal-related events, denosumab is cited as being noninferior to zoledronic acid. Denosumab is also associated with fewer renal adverse events than is zoledronic acid, possibly making it preferable in that setting, according to the update panel.