Info
Bone metastasis
Treat w/ bone-strengthening agent if CrCl > 30 to ↓ skeletal-related events; denosumab > zoledronic acid (JCO 2010;28:5132) Bisphosphonates: Zoledronic acid (4 mg IV q12wks) Anti-RANK ligand ab: Denosumab (120 mg SQ q4wks) Recommend preventive dentistry to avoid ONJ, Ca2+ monitoring (risk of hypocalcemia, esp w/ denosumab), & creatinine monitoring (esp w/ bisphosphonates) Monitoring H&P, labs (CBC, CMP, ± consider tumor markers), optional imaging (CT C/A/P w/ bone scan or PET/CT) every 2-4 cycles on chemo or as clinically indicated