Clinical Medicine Reviews in Oncology

Bone metastases can lead to serious problems such as fracture, spinal cord compression and severe bone pain and may require treatment with surgery or radiation therapy. The purpose of this paper is to discuss the comparative effects of denosumab (a novel, fully human, monoclonal antibody that inhibits the receptor activator of nuclear-factor-κB [RANK] ligand) and zoledronic acid (bisphosphonate) on the reduction or delay of serious complications associated with bone metastases in breast cancer patients. Medical literature on strictly conducted, randomized controlled trials was reviewed to understand the effects of denosumab and zoledronic acid on bone complications such as fracture, radiation to the bone, surgery to the bone, and spinal cord compression in breast cancer patients. The results of a phase 3 study showed that patients treated with denosumab remained free of bone complications longer than patients treated with zoledronic acid. The overall survival and time to cancer progression were similar among patients treated with zoledronic acid and patients treated with denosumab. Osteonecrosis of the jaw occurred with a similar frequency among patients treated with zoledronic acid and patients treated with denosumab. Based on the review of the literature, denosumab was more effective than zoledronic acid for delaying or preventing serious bone complications in breast cancer patients with bone metastases.