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Immediate versus delayed zoledronic acid for prevention of bone loss in postmenopausal women with breast cancer starting letrozole after tamoxifen-N03CC

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Abstract

Postmenopausal women with breast cancer (BC) are at increased risk for bone loss. Bisphosphonates improve bone mineral density (BMD) in normal postmenopausal women. The purpose of this study was to determine if immediate treatment with zoledronic acid preserves BMD in postmenopausal women with BC starting letrozole after tamoxifen. Postmenopausal women with BC completing tamoxifen were treated with daily letrozole 2.5 mg/vitamin D 400 I.U., calcium 500 mg twice daily and were randomized to upfront or delayed zoledronic acid 4 mg every 6 months. Patients in the delayed arm were only given zoledronic acid if they developed a post-baseline BMD T score <−2.0 or had a fracture. The primary endpoint was the mean percent change in lumbar spine (LS) BMD at 1 year. About 558 women enrolled; 395 provided 1 year BMD data. The upfront arm experienced a mean change of +3.66% in LS BMD versus -1.66% for the delayed group (P < 0.001). Changes at the femoral neck/total hip were also greater for the upfront versus delayed arms (P < 0.001; P < 0.001) with differences persisting at 2 years. Patients in the delayed arm were more likely to experience a clinically meaningful 5% loss of BMD at all sites versus the upfront zoledronate group. Patients in the upfront arm were slightly more likely to report limb edema, fatigue, fever, nausea and jaw osteonecrosis(1%). Upfront zoledronic acid prevents bone loss in postmenopausal women with BC starting letrozole after tamoxifen.

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Acknowledgments

This study was funded through the NCI with supplemental funding from Novartis. This study was conducted as a collaborative trial of the North Central Cancer Treatment Group and Mayo Clinic and was supported in part by Public Health Service grants CA-25224, CA-37404, CA-35431, CA-35415, CA-35103, and CA-35269. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute or the National Institutes of Health. This work was also supported by the following United States National Institutes of Health Grant-CA 124477 (PI Charles Loprinzi MD)

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Authors and Affiliations

  1. Mayo Clinic Jacksonville, Jacksonville, FL, 32224, USA

    Stephanie L. Hines & Edith A. Perez

  2. Private Practice, Jacksonville, FL, USA

    Betty Mincey

  3. Altru Health Systems, Grand Forks, ND, 58201, USA

    Todor Dentchev

  4. Mayo Clinic Foundation, Rochester, MN, 55905, USA

    Jeff A. Sloan, Steve Alberts, Heshan Liu & Charles L. Loprinzi

  5. Wichita Community Clinical Oncology Program, Wichita, KS, 67214-3882, USA

    David B. Johnson

  6. Toledo Community Hospital Oncology Program CCOP, Toledo, OH, 43623, USA

    Paul L. Schaefer

  7. Siouxland Hematology-Oncology Associates, Sioux City, IA, 51105, USA

    Stephen Kahanic

  8. Sioux Community Cancer Consortium, Sioux Falls, SD, 57105, USA

    Miroslaw A. Mazurczak

  9. Duluth CCOP, Duluth, MN, 55805, USA

    Daniel A. Nikcevich

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  1. Stephanie L. Hines
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  2. Betty Mincey
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  3. Todor Dentchev
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  4. Jeff A. Sloan
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  5. Edith A. Perez
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  7. Paul L. Schaefer
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  8. Steve Alberts
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  9. Heshan Liu
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  10. Stephen Kahanic
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  11. Miroslaw A. Mazurczak
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  12. Daniel A. Nikcevich
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  13. Charles L. Loprinzi
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Correspondence to Stephanie L. Hines.

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Hines, S.L., Mincey, B., Dentchev, T. et al. Immediate versus delayed zoledronic acid for prevention of bone loss in postmenopausal women with breast cancer starting letrozole after tamoxifen-N03CC. Breast Cancer Res Treat 117, 603–609 (2009). https://doi.org/10.1007/s10549-009-0332-2

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  • DOI: https://doi.org/10.1007/s10549-009-0332-2

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