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Bone-targeted therapy use in patients with bone metastases from lung cancer: A systematic review of randomized
Nathalie LeVasseur1, Mark Clemons2, Brian Hutton3
1Division of Medical Oncology and Department of Medicine, University of Ottawa, Ottawa, Canada.
Background:
Patients with advanced lung cancer commonly have bone metastases. Compared with other malignancies, the use of bone-targeted agents (e.g. bisphosphonates and denosumab) is less common in lung cancer patients. This may be due to the perception that bone-targeted agents are less effective in this population.
Objective:
To perform a systematic review to evaluate data from randomized trials of bone-targeted agents in lung cancer patients with bone metastases.
Methods:
A systematic search of Medline, Embase and the Cochrane Register of Controlled Trials through May 2015 was performed. Randomized trials of bone-targeted therapies in lung cancer patients with bone metastases were sought. Outcomes studied included skeletal related events (SREs), pain, quality of life, progression-free survival and overall survival. Random effects meta-analyses were planned if studies were judged homogeneous.
Results:
Of 632 abstracts, 17 publications describing 13 studies were included. Sample sizes ranged between 50 and 1776. Of 3379 patients, 1903 had lung cancer, with subgroup data available for 8 of 13 studies. Patient demographics were comparable, but enrollment criteria and endpoints were heterogeneous across studies, precluding meta-analysis. Study-specific results suggested that bone-modifying agents reduce the incidence of SREs and bone pain in lung cancer patients. Three studies suggested a survival benefit.
Conclusion:
Data from included trials suggests benefit of bone-targeted agents in lung cancer for the prevention of SREs and bone pain. There is a trend toward improvement in overall survival and progression-free survival, although further research is needed. Impact on quality of life and key subgroups for benefit both require future research.
Insights
Bone-targeted agents show promise for lung cancer patients with bone metastases, reducing skeletal events and pain. Further research is needed to confirm survival benefits and quality of life improvements.
Area of Science:
- Oncology
- Pharmacology
Background:
- Bone metastases are common in advanced lung cancer.
- Bone-targeted agents are underutilized in lung cancer patients.
- Perceived ineffectiveness may limit agent use.
Purpose of the Study:
- Systematically review randomized trials of bone-targeted agents in lung cancer with bone metastases.
- Evaluate agent efficacy in preventing skeletal-related events (SREs) and pain.
- Assess impact on survival and quality of life.
Main Methods:
- Systematic search of Medline, Embase, and Cochrane Register through May 2015.
- Included randomized trials of bone-targeted therapies in lung cancer patients with bone metastases.
- Analyzed outcomes including SREs, pain, quality of life, progression-free survival, and overall survival.
Main Results:
- 13 studies involving 3379 patients (1903 with lung cancer) were included.
- Bone-modifying agents reduced SREs and bone pain incidence.
- Three studies indicated a survival benefit, but meta-analysis was precluded by heterogeneity.
Conclusions:
- Bone-targeted agents benefit lung cancer patients by preventing SREs and bone pain.
- A trend towards improved survival exists, warranting further investigation.
- Future research should focus on quality of life and identifying key benefit subgroups.
