Bisphosphonates in the Adjuvant Setting of Breast Cancer Therapy-Effect on Survival: A Systematic Review and Meta-Analysis

Irit Ben-Aharon, Liat Vidal, Shulamith Rizel, Rinat Yerushalmi, Ofer Shpilberg, Aaron Sulkes, Salomon M. Stemmer

Research output: Contribution to journalArticlepeer-review

32 Scopus citations


Background:The role of bisphosphonates (BP) in early breast cancer (BC) has been considered controversial. We performed a meta-analysis of all randomized controlled trials (RCTs) that appraised the effects of BP on survival in early BC.Methods:RCTs were identified by searching the Cochrane Library, MEDLINE databases and conference proceedings. Hazard ratios (HRs) of overall survival (OS), disease-free survival (DFS) and relative risks of adverse events were estimated and pooled.Results:Thirteen trials met the inclusion criteria, evaluating a total of 15,762 patients. Meta-analysis of ten trials which reported OS revealed no statistically significant benefit in OS for BP (HR 0.89, 95% CI = 0.79 to 1.01). Meta-analysis of nine trials which reported the DFS revealed no benefit in DFS (HR 0.95 (0.81-1.12)). Meta-analysis upon menopausal status showed a statistically significant better DFS in the BP-treated patients (HR 0.81(0.69-0.95)). In meta-regression, chemotherapy was negatively associated with HR of survival.Conclusions:Our meta-analysis indicates a positive effect for adjuvant BP on survival only in postmenopausal patients. Meta-regression demonstrated a negative association between chemotherapy use BP effect on survival. Further large scale RCTs are warranted to unravel the specific subgroups that would benefit from the addition of BP in the adjuvant setting.

Original languageEnglish
Article numbere70044
JournalPLoS ONE
Issue number8
StatePublished - 26 Aug 2013
Externally publishedYes

ASJC Scopus subject areas

  • General


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