Bone-targeted agent treatment patterns and the impact of bone metastases on patients with advanced breast cancer in the United States

Abstract

Objective: Bone metastases are common among patients with advanced breast cancer, putting patients at increased risk of skeletal-related events (SREs). This study described impact of bone metastases, utilization of bone-targeted agents (BTAs) and physicians’ decision processes for BTA use in advanced breast cancer.

Methods: Data were collected using the Adelphi Breast Cancer Disease-Specific Programme in the United States. Physicians completed a detailed record for eligible patients (women ≥18 years, with stage IIIB–IV breast cancer).

Results: Data available from 1276 patients with advanced breast cancer included 485 (38%) with bone metastases. Most (80%) reported pain at bone metastasis diagnosis; of those reporting pain, 55% reported moderate to severe pain. Among patients with bone metastasis, 69% received a BTA. Reasons for initiating BTAs were bone pain (32%) and an estimated high risk of SREs (25%). Reasons for not treating with BTAs were very recent diagnosis (37%), poor Karnofsky performance status (14%), perceived low risk of SREs (11%) and short life expectancy (11%). Zoledronic acid (48%) and denosumab (42%) were commonly used BTAs; the main reasons for initiating BTA treatment were long-term safety (28% and 32%, respectively) and efficacy in delaying SREs (15% and 31%, respectively). The analysis was not adjusted for age or other possible confounders.

Conclusion: Bone pain is a common and sometimes severe symptom of bone metastases in advanced breast cancer and a common reason for initiating BTA treatment. Safety and efficacy were the main factors considered by physicians when selecting BTAs.

Keywords:

• Denosumab
• breast neoplasms
• neoplasm metastasis
• zoledronic acid
• pain

Transparency

Declaration of funding

The study was sponsored by Amgen Inc.

Author contributions

The individual author contributions are as follows: conception and design of the study, A.R., D.B., F.G., G.H. and Y.Q.; data collection, A.R. and J.D.C.; data analysis and interpretation, all authors. All authors were involved with the drafting and revising of the manuscript and provided final approval of the version to be published. All authors agree to be accountable for all aspects of the work.

Declaration of financial/other relationships

D.H. has disclosed that he has received honoraria from Amgen for consulting/advisory board activities. R.v.M. has disclosed that he has served as a consultant for Bayer and Roche (honoraria paid to institution) and for Amgen, Bristol-Myers Squibb and Merck-Serono, and received research funding from Bayer and Merck-Serono. J.J.B. has disclosed that he received honoraria and travel reimbursement from, and served as a consultant for, Amgen. A.R. and J.D.C. have disclosed that they are employed by Adelphi Real World, which received funding from Amgen to conduct the study analysis. D.B., F.G., G.H. and Y.Q. have disclosed that they are employed by Amgen and own Amgen stock.

CMRO peer reviewers on this manuscript have received an honorarium from CMRO for their review work, but have no relevant financial or other relationships to disclose.

Previous presentation

Data previously presented at the ISPOR 18th Annual European Congress; 2015 Nov 7–11; Milan, Italy; and at the Breast Cancer Symposium; 2015 Sep 25–27; San Francisco, CA, USA.

Acknowledgments

Rick Davis (Complete Healthcare Communications LLC, a CHC Group company, North Wales, PA) and Albert Rhee (Amgen Inc.) provided medical writing support, which was paid for by Amgen Inc.