Anti-osteolytic use to prevent skeletal related events in solid tumour bone metastases

Abstract

Abstract Background Bone metastases from solid tumours remain a serious burden on patient morbidity leading to decreased quality of life, increased narcotic use, and higher healthcare cost. We examined the current use of anti-osteolytics including RANK-L inhibitors and Bisphosphonates with the frequency of Skeletal Related Events (SRE) in coordination with current ESMO treatment guidelines. Methods Patients with bone metastases from solid tumours in the University of Pennsylvania Hospital system (UPHS) between August 2014 and August 2019 were identified. Data regarding treatment of metastases and frequency of SREs were obtained from patient charts in EPIC EMR. This included: type of therapy, documented SRE, and documented reasoning for lack of treatment. SREs were defined as pathological fractures, spinal cord compression, radiotherapy/surgery for fracture risk, and chronic metastatic bone pain. Descriptive statistical analyses and a single two variable relative risk analysis were performed to evaluate data. Results 400 patients were identified in the UPHS to have bone metastases from solid tumours. 240 (65%) received anti-osteolytic treatment while 140 (35%) did not. The total number of SREs numbered 173 (43%). Of those receiving treatment 173 (63%) were treated with denosumab while 87 (33%) were treated with a bisphosphonate. Lack of anti-osteolytic therapy reasoning was documented in 41 cases (29%) while 99 cases (71%) had no documented reasoning. In patients who did receive treatment there was an absolute 16% reduction in SREs from 54% without treatment to 38% with (Relative risk: .540, 95% Confidence Interval: .438 to .666, P-Value: Conclusions The use of anti-osteolytic treatment after diagnosis of bone metastasis was associated with a decrease in the risk of subsequent SREs. However, at 65% use, it would appear that these drugs are being underutilized and could better be employed in accordance with current ESMO guidelines so as to optimize patient care. We suggest further study to better understand reasoning behind lack of use, timing of SREs, and associated metastatic risk in regards to primary tumor type. Legal entity responsible for the study University of Pennsylvania Hospital System - Pennsylvania Hospital. Funding Has not received any funding. Disclosure All authors have declared no conflicts of interest.