Most Read Articles
5 days ago
A strong belief in the necessity of medication is associated with better adherence to oral disease-modifying antirheumatic drugs (DMARDs) or prednisone, while higher self-efficacy correlates with poor adherence, in a diverse cohort of patients with rheumatoid arthritis (RA), suggests a study.
4 days ago
Low-dose administrations of haloperidol after thoracic surgery does not appear to prevent postoperative delirium, according to a new study.
2 days ago
Percutaneous coronary intervention (PCI) displays comparable rates of mortality and serious composite outcomes but a higher rate of target-vessel revascularization at 10 years relative to coronary artery bypass grafting (CABG) in patients with significant left main coronary artery (LMCA) disease, reports a study. On the other hand, CABG delivers lower mortality and serious composite outcome rates compared with PCI with drug-eluting stents after 5 years.
Pearl Toh, 4 days ago
Apixaban slashes the risk of recurrent venous thromboembolism (VTE) by 90 percent in cancer patients compared with the low-molecular-weight heparin (LMWH) dalteparin, with no increase in major bleeding risk, according to the ADAM VTE study presented at ASH 2018.

Denosumab can prevent chemo-induced secondary BMD loss in GI cancer patients

Pearl Toh
04 Dec 2018

Administration of the RANKL* inhibitor denosumab prior to chemotherapy initiation may prevent secondary reduction in bone mineral density (BMD) induced by chemotherapy, according to the ESPRESSO-02 study presented at ESMO Asia 2018.

The previous ESPRESSO-01 study has shown that the reduction in BMD after only 16 weeks of chemotherapy with short-term periodic glucocorticoid premedication for GI cancer was comparable to that seen with 12-month adjuvant therapy with aromatase inhibitor for early-stage breast cancer patients. [Oncologist 2017;22:592-600]

In the current multicentre prospective ESPRESSO-02 study, 42 patients (median age 68 years, 42.9 percent male) with GI cancer received a single subcutaneous injection of denosumab 60 mg within a week before the induction of chemotherapy with glucocorticoid premedication. Intravenous steroid premedication was given either weekly, biweekly, or triweekly, with steroid-free intervals of >4 weeks not allowed. All patients were also supplemented with calcium 610 mg daily and vitamin D 400 IU daily. [ESMO Asia 2018, abstract 440P]      

Sixteen weeks after chemotherapy initiation, BMD levels were significantly increased from baseline in 73.2 percent of the patients, at an average rate of +2.8 percent in the lumbar spine (p<0.0001).

In comparison, 74.3 percent of the participants who did not receive denosumab prior to chemotherapy induction in ESPRESSO-01 saw their lumbar spine BMD levels decreased by an average of 1.89 percent from baseline (p<0.0001).     

“The lower limit of 95 percent confidence interval of BMD variation rate in this study was +1.350 and the primary endpoint was met,” the researchers stated.

In addition, BMD in the total hip (mean, +1.36 percent; p=0.004) and femoral neck (mean, +1.95 percent; p=0.022) also increased significantly at 16 weeks compared with baseline in the ESPRESSO-02 study.    

Other markers of bone turnover such as serum bone alkaline phosphatase (sBAP) and serum cross-linked N-telopeptides of type I collagen (sNTX) levels were decreased by 29.44 percent (p<0.0001) and 37.95 percent (p=0.034), respectively.

Furthermore, subgroup analysis showed that the protective effect of denosumab against chemotherapy-induced BMD loss was consistent across subgroups, regardless of age, gender, primary tumour site, treatment duration, additive oral steroid use, and baseline T-score.

No incidence of bone fracture was reported among the participants.

“We found that denosumab administration could prevent the secondary reduction of BMD,” the researcher concluded. “Further studies are needed to evaluate on the effectiveness of long-term prognosis, quality of life, and cost.”

  

Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Gastroenterology - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
5 days ago
A strong belief in the necessity of medication is associated with better adherence to oral disease-modifying antirheumatic drugs (DMARDs) or prednisone, while higher self-efficacy correlates with poor adherence, in a diverse cohort of patients with rheumatoid arthritis (RA), suggests a study.
4 days ago
Low-dose administrations of haloperidol after thoracic surgery does not appear to prevent postoperative delirium, according to a new study.
2 days ago
Percutaneous coronary intervention (PCI) displays comparable rates of mortality and serious composite outcomes but a higher rate of target-vessel revascularization at 10 years relative to coronary artery bypass grafting (CABG) in patients with significant left main coronary artery (LMCA) disease, reports a study. On the other hand, CABG delivers lower mortality and serious composite outcome rates compared with PCI with drug-eluting stents after 5 years.
Pearl Toh, 4 days ago
Apixaban slashes the risk of recurrent venous thromboembolism (VTE) by 90 percent in cancer patients compared with the low-molecular-weight heparin (LMWH) dalteparin, with no increase in major bleeding risk, according to the ADAM VTE study presented at ASH 2018.