European Breast Cancer Conference, Vienna, March 2012

Chemotherapy with endocrine therapy and bisphosphonates in early breast cancer

Professor Michael Gnant – Medical University of Vienna, Austria

The debate is about a question we have rather controversially discussed in recent years: whether the adjuvant use of bisphosphonates should be considered for patients or not. I’m speaking in favour of the motion and I think it’s going to be rather easy because we have now several large clinical trials clearly demonstrating that this treatment provides benefits for patients, first protecting bone against the side effects of our usual endocrine interventions but, beyond that, also providing anti-cancer benefits which will result in better outcomes. This has been demonstrated in premenopausal patients in ABCSG-12, postmenopausal patients in AZURE as well as in ZO-FAST. So I’ve pretty good evidence, even in the absence of general availability of that treatment, but that’s a problem that is going to go away because most of these drugs will be generic very soon so they are even cheaper than they were before. So I think we’re quite clear that this is part of the treatment of breast cancer.

What are the arguments against bisphosphonates being part of the routine treatment of early breast cancer?

It was a little bit of a hilly road, I would say, the development of that knowledge because first it occurred relatively late in the lifecycle of these drugs so that means limited research resources. Second, it’s important to realise that this treatment may not be for all breast cancer patients, it apparently has to do with whether these patients are in what we call a low oestrogenic environment, either by age or by other treatment means. So you have to carefully select your patients for that treatment.