Bone Pain After Breast Cancer Treatment Managed Effectively With Common Medication


A prophylactic therapy is effective in preventing treatment-associated mild-to-moderate bone pain in breast cancer, according to a study published in Supportive Care in Cancer (online November 16, 2017; doi:10.1007/s00520-017-3959-2).

Mild-to-moderate bone pain is a common side effect associated with pegfilgrastim supportive therapy to chemotherapy for breast cancer. This adverse event may lead to discontinuation of treatment, which could further result in increased rates of infection, hospitalization, and mortality.

Jeffrey J Kirshner, MD, Hematology-Oncology Associates of Central New York (East Syracuse, NY), and colleagues conducted a study to evaluate prophylactic naproxen or loratadine vs no prophylactic treatment on pegfilgrastim-associated bone pain. The open-label study enrolled 600 patients with stage I-III breast cancer who were planning to undergo at least four cycles of adjuvant or neoadjuvant chemotherapy with pegfilgrastim support starting in cycle 1. Patients were randomly assigned (1:1:1) to receive naproxen, loratadine, or no treatment to prevent pegfilgrastim-associated bone pain.

The primary endpoint of the study was all-grade bone pain in cycle 1 from adverse events reporting, while secondary endpoints included bone pain in cycles 2-4 and across all cycles from adverse events reporting and patient-reported bone pain by cycle and across all cycles.

Results of the study showed that patients with all-grade bone pain in cycle 1 from adverse events reporting was 40.3% in those receiving naproxen, 42.5% in those receiving loratadine, and 46.6% in those receiving no prophylaxis. However, researchers acknowledged that differences between the treatment groups were not statistically significant.


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The rates of adverse events were 15.5% and 3.5% among patients receiving naproxen compared with loratadine, respectively. Additionally, patients receiving loratadine were less likely to discontinue treatment due to adverse events compared with those receiving naproxen.

In their concluding remarks, Dr Kirshner and colleagues wrote that “Given its tolerability, its ease of administration, and its potential benefit, treatment with loratadine should be considered to help prevent bone pain in patients receiving chemotherapy and pegfilgrastim.”—Zachary Bessette