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Original research
Bone-targeting agents in major solid tumour metastases: a multinational cohort study
  1. Ju Hwan Kim1,
  2. Chin-Yao Shen2,
  3. Philip Chun-Ming Au3,
  4. Yeon-Hee Baek1,
  5. Ching-Lung Cheung3,
  6. Wei-Pang Chung4,5,
  7. Nora Joelle Kleinman6,
  8. Tai Chung Lam7,
  9. Tzu-Chi Liao2,
  10. Tzu-Chieh Lin8,
  11. Ju-Young Shin1,9,
  12. Chor-Wing Sing3,
  13. Ian Chi Kei Wong3,10 and
  14. Edward Chia-Cheng Lai2,11
  1. 1 School of Pharmacy, Sungkyunkwan University, Suwon, Republic of Korea
  2. 2 School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
  3. 3 Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong SAR
  4. 4 Department of Oncology, National Cheng Kung University Hospital, Tainan, Taiwan
  5. 5 Center of Applied Nanomedicine, National Cheng Kung University, Tainan, Taiwan
  6. 6 Amgen Asia Holdings, Hong Kong, Hong Kong SAR
  7. 7 Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong SAR
  8. 8 Center for Observational Research, Amgen, Thousand Oaks, California, USA
  9. 9 Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea
  10. 10 Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
  11. 11 Department of Pharmacy, National Cheng Kung University Hospital, Tainan, Taiwan
  1. Correspondence to Dr Edward Chia-Cheng Lai, School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan; edward_lai{at}mail.ncku.edu.tw

Abstract

Objective To describe the epidemiology, clinical characteristics and utilisation patterns of bone-targeting agents (BTAs) in patients with bone metastases from breast, prostate and lung cancer.

Methods This is a multinational retrospective cohort study including patients with three major solid tumours (breast, prostate and lung cancer) and newly initiated on BTAs (ie, denosumab, zoledronic acid and pamidronate). Records were retrieved from nationwide health databases from Hong Kong and Taiwan (HK and TW: 2013–2017) and Korea (KR: 2012–2016). Descriptive analyses included the annual incidence rates of bone metastases and the cumulative incidence curves of BTA initiation. We used Sankey diagrams to visualise the dynamic BTA utilisation patterns.

Results The annual incidence rate of bone metastases ranged from 3.5% to 4.5% in TW, from 9.6% to 10.3% in HK and from 2.9% to 3.8% in KR. We identified 14.1% (5127), 9.3% (883) and 9.4% (4800) of patients with bone metastases newly initiated on BTAs in TW, HK and KR, respectively. The most frequently used BTA in TW (67.1%) and HK (51.9%) was denosumab, while in KR (84.8%) it was zoledronic acid. Sankey diagrams indicated the proportion of patients remaining on denosumab was highest in TW and HK, while it was zoledronic acid in KR. Specifically, in TW, patients who were on bisphosphonates or had discontinued treatment frequently switched to or reinitiated denosumab.

Conclusions We found the rate of BTA utilisation remained low across all sites and tumour types in recent years. The dynamic utilisation patterns of BTAs provide better understanding of the treatment landscape for future evaluation of associated outcomes of patients.

  • bone
  • prostate
  • breast
  • lung

Data availability statement

Data may be obtained from a third party and are not publicly available. We used a distributed network approach and executed the analysis independently from each site on the basis of a common protocol. The coordinating centre, the National Cheng Kung University, Taiwan, only collected summary results from each site without access to individual data. The data sets analysed in the current study will not be available to the public due to data privacy regulations in each participating country. Qualified researchers may request data from the corresponding author.

https://doi.org/10.1136/bmjspcare-2021-003062

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    Data availability statement

    Data may be obtained from a third party and are not publicly available. We used a distributed network approach and executed the analysis independently from each site on the basis of a common protocol. The coordinating centre, the National Cheng Kung University, Taiwan, only collected summary results from each site without access to individual data. The data sets analysed in the current study will not be available to the public due to data privacy regulations in each participating country. Qualified researchers may request data from the corresponding author.

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    Footnotes

    • JHK and C-YS contributed equally.

    • Contributors Conceptualisation, methodology and writing - review and editing: all authors. Data curation: EC-CL (Taiwan NHID), C-LC (Hong Kong’s Clinical Data Analysis and Reporting System) and J-YS (Korea’s NHID). Funding acquisition: EC-CL. Investigation: EC-CL, C-LC and J-YS. Project administration: C-YS. Software, resources, formal analysis, validation and visualisation: JHK, C-YS, PC-MA, Y-HB, T-CLia and C-WS. Supervision: EC-CL, C-LC and J-YS. Writing - original draft: JHK and C-YS. Guarantor for overall content: EC-CL.

    • Funding This work was supported by a research grant from Amgen and research agreements between National Cheng Kung University, Taiwan, University of Hong Kong, Hong Kong, and Sungkyunkwan University, Korea.

    • Competing interests C-LC reports receipt of funding from Amgen and Abbott, outside the submitted work. J-YS reports receipt of research funding from the Ministry of Food and Drug Safety, the Ministry of Health and Welfare, and the National Research Foundation of the Republic of Korea, and grants from pharmaceutical companies including Amgen, Pfizer, Hoffmann-La Roche, Dong-A ST and Yungjin, outside the submitted work. EC-CL reports receipt of research funding from the Ministry of Science and Technology and the Ministry of Health and Welfare of Taiwan, and grants from pharmaceutical companies including Amgen and Takeda, outside the submitted work. Amgen Asia Holdings was the affiliation of NJK at the time of conduct of the study.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.