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01-04-2018 | Review Article

Denosumab versus bisphosphonates in patients with advanced cancers-related bone metastasis: systematic review and meta-analysis of randomized controlled trials

Authors: Amr Menshawy, Omar Mattar, Ali Abdulkarim, Shiref Kasem, Noha Nasreldin, Esraa Menshawy, Salahuddean Mohammed, Mohamed Abdel-Maboud, Mohamed Gadelkarim, Gehad Gamal El Ashal, Ahmed Saber Elgebaly

Published in: Supportive Care in Cancer | Issue 4/2018

Abstract

Background

Bone metastasis is reported to be associated with poor quality of life, and increased risk of hospitalization. We aim to synthesize evidence from published randomized controlled trials (RCTs) which compared the efficacy of denosumab versus bisphosphonates in patients with advanced cancers.

Methods

We searched for all published RCTs in the following electronic databases: PubMed, Scopus, Web of Science, and Cochrane Central. Retrieved records were screened for eligibility. Time-to-event data were pooled as hazard ratio (HR) using the generic inverse-variance method and dichotomous data were pooled as relative risk (RR) in a random-effect model. We used Review Manager 5.3 for windows.

Results

Six unique RCTs with a total of 7722 patients were included. Overall effect estimates favored denosumab group in comparison to intravenous (IV) bisphosphonates in the following terms: time to first skeletal-related events (HR 0.92, 95% CI [0.86, 0.98], p = 0.01), time to subsequent skeletal-related event (RR 0.92, 95% CI [0.86, 0.99], p = 0.03), and radiation to bone (RR 0.81, 95% CI [0.71, 0.92], p = 0.02). Denosumab group was associated with increased risk of grade 3 or 4 hypocalcaemia (RR 1.99, 95% CI [1.11, 3.54], p = 0.02) and reduced risk of renal impairment or toxicity (RR 0.75, 95% CI [0.61, 0.91], p = 0.003) in comparison to IV bisphosphonates group. Pooled studies were homogenous.

Conclusion

Denosumab showed a favorable significant impact on delaying the time to first skeletal-related event and reducing the incidence of radiation to the bone event in comparison to bisphosphonates, with similar efficacy regarding overall survival and time to disease progression. Further large-scale and long-term studies are needed to clarify the long-term efficacy and safety of both regimens.

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Title: Denosumab versus bisphosphonates in patients with advanced cancers-related bone metastasis: systematic review and meta-analysis of randomized controlled trials
Authors: Amr Menshawy
Omar Mattar
Ali Abdulkarim
Shiref Kasem
Noha Nasreldin
Esraa Menshawy
Salahuddean Mohammed
Mohamed Abdel-Maboud
Mohamed Gadelkarim
Gehad Gamal El Ashal
Ahmed Saber Elgebaly
Publication date: 01-04-2018
Publisher: Springer Berlin Heidelberg
Published in: Supportive Care in Cancer / Issue 4/2018
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-018-4060-1

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Abstract

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