New Clinical Practice Guidelines, November 2017

John Anello; Brian Feinberg; Richard Lindsey; Cristina Wojdylo; Olivia Wong, DO; Yonah Korngold; John Heinegg; Sam Shlomo Spaeth


November 08, 2017

In This Article

Metastatic Breast Cancer Treatment

American Society of Clinical Oncology and Cancer Care Ontario

Patients with breast cancer who have evidence of bone metastases should be treated with bone-modifying agents (BMAs). Options include denosumab, 120 mg subcutaneously every 4 weeks; pamidronate, 90 mg intravenously every 3 to 4 weeks; or zoledronic acid, 4 mg intravenously every 12 weeks or every 3 to 4 weeks.

The analgesic effects of BMAs are modest, and they should not be used alone for bone pain.

Recommend that the current standard of care for supportive care and pain management—analgesia, adjunct therapies, radiotherapy, surgery, systemic anticancer therapy, and referral to supportive care and pain management—be applied.

Evidence is insufficient to support the use of one BMA over another.


  • Van Poznak C, Somerfield MR, Barlow WE, et al. Role of bone-modifying agents in metastatic breast cancer: an American Society of Clinical Oncology–Cancer Care Ontario focused guideline update. J Clin Oncol. 2017 Oct 16.

  • Douglas D. Guidelines on bone-modifying agents in metastatic breast cancer updated. Reuters Health Information. October 27, 2017.


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