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Bone-targeted Therapy — SCE Medical Oncology MCQ

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ModerateSupportive & Palliative OncologyBone-targeted TherapySCE Medical Oncology

A 50-year-old woman with metastatic breast cancer and bone metastases has been on zoledronic acid for 2 years. Recent evidence suggests modified dosing schedules. What does the OPTIMIZE-2 and ZOOM trials evidence suggest?

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Correct answer: D — After 1-2 years of monthly dosing, de-escalation to 3-monthly (every 12 weeks) zoledronic acid is non-inferior for skeletal-related event prevention

The OPTIMIZE-2, ZOOM and CALGB 70604 trials demonstrated that after an initial period of monthly (4-weekly) bisphosphonate therapy (typically 1-2 years), de-escalation to 12-weekly (3-monthly) dosing is non-inferior for skeletal-related event prevention. This reduces drug exposure, renal toxicity risk, and treatment burden. ASCO and ESMO guidelines now endorse 12-weekly dosing after the initial monthly phase. The same principle applies to denosumab (REDUSE trial evaluating de-escalation).

Reference: ESMO 2024 Bone Health Guidelines; OPTIMIZE-2; CALGB 70604; ASCO Bone Modifying Agent Guidelines 2021