Bone-Modifying Agents in Metastatic Breast Cancer

Publication Date: October 16, 2017



  • Patients with breast cancer who have evidence of bone metastases should be treated with BMAs. (Strong Recommendation: EB-H)
    • One BMA is not recommended over another.
    • Options include:
      • denosumab, 120 mg subcutaneously, every 4 weeks;
      • pamidronate, 90 mg intravenously, every 3–4 weeks; or
      • zoledronic acid, 4 mg intravenously, over no less than 15 minutes,
        every 12 weeks or every 3–4 weeks.
  • The analgesic effects of BMAs (denosumab, pamidronate, or zoledronic acid) are modest. They should not be used alone for bone pain.
    (Weak Recommendation: EB-L).
    • The current standard of care for supportive care and pain management should be applied. This can include analgesia, adjunct therapies, radiotherapy, surgery, systemic anti-cancer therapy, and referral to supportive care and pain management.
    • Evidence of a clinically meaningful benefit is insufficient to support the use of one bone-modifying agent over another.



...anged from 2011...

...recommended for patients with metastatic breast c...

Table 1. Route of Administration, Dose, and Sche...