Clinical considerations for the use of antiresorptive agents in the treatment of metastatic bone disease

Improved therapies for advanced cancers have prolonged the survival of patients with malignant bone disease (MBD), leading to long-term treatment to prevent skeletal-related events (SREs). Selecting the most suitable antiresorptive agent is influenced by efficacy, practicality of administration, safety, cost, and patient compliance. Intravenous bisphosphonates are an established standard of care for patients with MBD, and denosumab recently gained regulatory approval in the United States for reducing the risk of SREs in patients with MBD from solid tumors. This review examines the pharmacokinetic and pharmacodynamic properties of different antiresorptives in the context of clinical decision making for the treatment of MBD. Continuous, regular treatment with antiresorptives has been shown to provide the greatest protection against SREs. However, continuous treatment is not always achievable over a prolonged period, and differences in pharmacodynamics between various antiresorptives might influence the potential preservation of treatment benefits during such gaps in therapy.