Denosumab for the Prevention of Skeletal-Related Events in Breast Cancer Bone Metastasis: A Literature Review: Literature Review

TABOURI Sarah; ADJMI Samir; ABDELLALI Ahmed; MOUISSAT Imad Zakarya

doi:10.58372/2835-6276.1339

Authors

TABOURI Sarah
ADJMI Samir
ABDELLALI Ahmed
MOUISSAT Imad Zakarya

DOI:

https://doi.org/10.58372/2835-6276.1339

Keywords:

breast cancer, denosumab, bone metastases, skeletal-related events

Abstract

Background: Breast cancer is the leading cause of cancer-related mortality among women worldwide, with more than 90% of these deaths attributed to metastases ^[1]. Among patients with metastatic breast cancer, approximately 65% to 75% develop bone metastases ^[1,2].These metastases are responsible for serious skeletal-related events (pain, pathological fractures, spinal cord compression, hypercalcaemia). RANKL inhibitors, particularly denosumab (Xgeva®), represent a major therapeutic option in preventing bone complications related to these metastases. We therefore aim to conduct a literature review to evaluate the efficacy and safety of denosumab (Xgeva®) in the prevention of skeletal complications in patients with breast cancer and bone metastases.

Methods: A literature review was conducted using PubMed and MEDLINE databases from 2014 to 2025. The keywords used were « breast cancer », « denosumab » and « bone metastases ». A total of 140 articles were initially identified. After screening the abstracts, 31 articles were selected for full-text review, and 20 were finally included in the analysis.

Results /Discussion: This review demonstrated that denosumab (Xgeva®) significantly delays the onset of the first skeletal-related event in patients with breast cancer and bone metastases, reducing the risk by 14% to 24%^[3–6]. Denosumab also significantly lowers the incidence of fractures in both premenopausal and postmenopausal women^[3,7,8]. Compared to zoledronic acid, it reduces this risk by 23%^[9]. Regarding bone pain, treatment with denosumab significantly delays the onset or worsening of pain in patients with moderate to severe pain^[4,10,11], with a 17% risk reduction (p = 0.003)^[10] . Denosumab also appears to reduce the risk of spinal cord compression ^[4,8,13] . According to Charles L., the probability of spinal cord compression under denosumab is estimated at 8 per 10000 per month, and 2 per 1000 over three months (9). Similarly, Stopeck et al. reported a probability of 0.06% (0.0006)^[7] .

Conclusion: Denosumab (Xgeva®) is considered a reference treatment strategy for preventing bone complications related to bone metastases in breast cancer by delaying serious skeletal events such as pathological fractures and spinal cord compression. Careful monitoring is essential to manage potential side effects, including osteonecrosis of the jaw and hypocalcaemia.

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