Patterns of care for patients with metastatic bone disease in solid tumors: A cross-sectional study from Switzerland (SAKK 95/16)

Michael Mark; Beat Thürlimann; Karin Ribi; Corinne Schär; Daniel Dietrich; Richard Cathomas; Ursina Zürrer-Härdi; Thomas von Briel; Sandro Anchisi; Pierre Bohanes; Veronika Blum; Philipp von Burg; Meinrad Mannhart; Clemens B Caspar; Roger von Moos

doi:10.1016/j.jbo.2019.100273

Patterns of care for patients with metastatic bone disease in solid tumors: A cross-sectional study from Switzerland (SAKK 95/16)

J Bone Oncol. 2019 Dec 16:21:100273. doi: 10.1016/j.jbo.2019.100273. eCollection 2020 Apr.

Authors

Affiliations

¹ Department of Hematology/Oncology, Kantonsspital Graubünden, Loestrasse 170, 7000 Chur, Switzerland.
² Kantonsspital St. Gallen, St. Gallen, Switzerland.
³ International Breast Cancer Study Group IBCSG (IBCSG), Bern, Switzerland.
⁴ Swiss Group for Clinical Cancer Research (SAKK) Coordinating Center, Bern, Switzerland.
⁵ Kantonsspital Winterthur, Winterthur, Switzerland.
⁶ Klinik Hirslanden, Zürich, Switzerland.
⁷ Hôpital du Valais, Sion, Switzerland.
⁸ Centre de Chimiothérapie Anti-Cancéreuse, Lausanne, Switzerland.
⁹ Kantonsspital Luzern, Luzern, Switzerland.
¹⁰ Burgerspital Solothurn, Solothurn, Switzerland.
¹¹ Andreasklinik Cham Zug, Cham, Switzerland.
¹² Kantonsspital Baden, Baden, Switzerland.

Abstract

Background: Bone-targeted agents (BTAs) are widely used in the management of patients with bone metastases from solid tumors, but knowledge of their routine care use and the therapeutic implications remains limited. This non-interventional study aimed to characterize real-world BTA patterns of care in Switzerland.

Materials and methods: Non-interventional, cross-sectional study involving oncologists from across Switzerland who completed a Treating Physician questionnaire, providing data on their clinical setting and BTA-related practices, and a Patient Characteristics and Treatment questionnaire, providing data on their patients' disease status, risk of bone complications, BTA regimen and related outcomes. Eligible patients were aged ≥ 18 years, with solid tumors and at least one bone metastasis and were receiving routine management at the participating physician's center over the 3-month study period.

Results: A total of 86 oncologists recruited 417 patients from across 18 centers in Switzerland (80% public hospitals; 20% private clinics). The majority of physicians (70.9%) reported prescribing BTAs in line with international guidelines; denosumab was the treatment of choice in 78.5% of patients. BTAs were widely administered (94.2%) according to a 3-4-weekly dosing regimen; 33.7% of physicians reported extending intervals to 12 weeks after an initial 2 years of treatment. Physicians appeared to use clinical judgement, as well as formal risk assessment, to guide treatment for symptomatic skeletal events. No association was seen between either BTA use, or risk of complications, and incidence of skeletal complications. Only 4.3% of patients were reported to be experiencing severe bone pain at the time of the study.

Conclusions: This cross-sectional, non-interventional study found high implementation of guideline-recommended BTA prescribing, good pain control and low incidence of skeletal-related events. Long-term BTA randomized controlled trials have the potential to further optimize routine care outcomes for patients.

Keywords: BP, bisphosphonate; BTA, bone-targeted agent; Bone metastases; Bone-targeting agents; HRQoL, health-related quality of life; IBCSG, International Breast Cancer Study Group; Non-interventional; Patterns of care; RANKL, receptor activator of nuclear factor kappa-B ligand; RCT, randomized controlled trial; SAKK, Swiss Group for Clinical Cancer Research; SGMO, Schweizerische Gesellschaft für Medizinische Onkologie; SRE, symptomatic skeletal-related event; SSE, symptomatic skeletal event; Skeletal-related event; Symptomatic skeletal events; mCRPC, metastatic castration-resistant prostate cancer.