Patient group | First-/Second-line | Duration |
Metastatic cancer
|
4 to 12-weekly IV zoledronic acid OR 4 to 12-weekly subcutaneous denosumab |
As long as clinically appropriate |
Early breast cancer
|
6-weekly IV zoledronic acid for 3 cycles followed by EITHER daily oral ibandronate OR 6-monthly IV zoledronic acid |
Up to 3 years |
Early breast cancer
|
Daily oral ibandronate OR 6-monthly IV zoledronic acid | Up to 3 years |
Multiple myeloma | 4-weekly IV zoledronic acid OR daily oral sodium clodronate See Guideline: Bisphosphonate Use in Myeloma Patients |
|
Prostate cancer
|
3 to 4-weekly IV zoledronic acid | As long as clinically appropriate |
Lung cancer
|
3 to 4-weekly IV zoledronic acid | Concurrently with first-line systemic anticancer treatment, stopped at the end of course; repeated during second-line treatment if required |
Renal cancer
|
3 to 4-weekly IV zoledronic acid | As long as clinically appropriate (Note increased risk of osteonecrosis of the jaw with concurrent tyrosine kinase inhibitors) |
Other solid tumour*
|
IV zoledronic acid may be considered a treatment option where there is evidence to do so | As long as clinically appropriate |
NB: Onset of treatment effect of zoledronic acid may be 2 to 3 months from initiation of therapy.
† Adjuvant bisphosphonates are only recommended for use in women who are postmenopausal, unless the adjuvant/neoadjuvant treatment plan includes ovarian suppression therapy (i.e. GnRH agonist) or oophorectomy. Consultant decision.
*Non-formulary approval will be required.