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Denosumab in patients with cancer and skeletal metastases: a systematic review and meta-analysis

Prashanth Peddi1, Maria A Lopez-Olivo, Gregory F Pratt

  • 1Division of General Internal Medicine, The University of Texas, MD Anderson Cancer Center, Houston, TX 77030, USA.

Cancer Treatment Reviews
|August 18, 2012
PubMed
Abstract

Insights

Denosumab effectively reduces skeletal-related events (SRE) in patients with bone metastases compared to zoledronic acid, delaying SRE onset. Overall survival and adverse event rates were similar, though denosumab increased hypocalcemia risk.

Area of Science:

  • Oncology
  • Pharmacology
  • Clinical Medicine

Background:

  • Bone metastases significantly impact patient morbidity and mortality.
  • Skeletal-related events (SRE) are common complications in patients with bone metastases.
  • Bisphosphonates and denosumab are key treatments for managing bone metastases.

Purpose of the Study:

  • To systematically review the efficacy and safety of denosumab in reducing SRE in patients with bone metastases.
  • To compare denosumab with zoledronic acid regarding SRE incidence, time to SRE, and overall survival.
  • To evaluate the impact of denosumab on pain, quality of life, bone turnover markers, and adverse events.

Main Methods:

  • Systematic literature review of controlled clinical trials up to March 14, 2012.
  • Searches conducted in MEDLINE, EMBASE, Web of Science, and The Cochrane Library.
  • Data extraction by two independent reviewers focusing on SRE, survival, pain, quality of life, and adverse events.

Main Results:

  • Denosumab showed a lower incidence of SRE (RR 0.84) and delayed time to first SRE (RR 0.83) compared to zoledronic acid.
  • No significant difference in overall survival (HR 0.98) or total adverse events (RR 0.97) was observed.
  • Denosumab increased the risk of hypocalcemia (RR 1.9) but showed no significant difference in osteonecrosis of the jaw frequency.

Conclusions:

  • Denosumab is more effective than zoledronic acid in reducing SRE incidence and delaying SRE onset in patients with bone metastases.
  • No significant differences were found in overall mortality or the frequency of overall adverse events between denosumab and zoledronic acid.
  • Clinicians should monitor calcium levels due to an increased risk of hypocalcemia with denosumab.

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