REthinking Clinical Trials



De-escalating BMA treatment after two years vs continuing

Principal Investigator(s): Dr. Terry Ng NCT04549207
While informal surveys of oncologists and patients have suggested that they would not want to discontinue BMA therapy entirely after 2 years of treatment, they are interested in de-escalating to treatment every 24 weeks, and this de-escalated interval is supported by data from the osteoporosis population. Indeed, clinical experience shows that many oncologists already further de-escalate and sometime stop prescriping BMAs in patients who have been on these agents for several years. This study is the first pragmatic, multicentre, open-label, randomized clinical trial to evaluate the efficacy and safety of either continuing or further de-escalating BMA after a minimum of two years of BMA treatment in patients with bone metastases from breast cancer and metastatic castration-resistant prostate cancer.

Funded by a TOHAMO Innovation grant.

Sites: The Ottawa Hospital

Tags: Castration-resistant prostate cancer Metastatic breast cancer


Systematic Review:

  • Long-term impact of bone-modifying agents for the treatment of bone metastases: a systematic review. Ng et al, 2020. PMID: 32535678


  • Real-world practice patterns and attitudes towards de-escalation of bone-modifying agents in patients with bone metastases from breast and prostate cancer: A physician survey. AlZharani et al, 2020. PMID: 33294318
  • Perceptions around bone-modifying agent use in patients with bone metastases from breast and castration resistant prostate cancer: A patient survey. Alzahrani et al. 2021. PMID: 34023950