AGO Recommendations for the Diagnosis and Treatment of Patients with Advanced and Metastatic Breast Cancer: Update 2016.

Bone Health Endocrine treatment with aromatase inhibitors (AIs) is associated with significant bone loss in most of postmenopausal women. Therefore, preventive measures should be undertaken including exercise, vitamin D (800–2000 U/day), reducing alcohol, cessation of smoking and avoiding a body mass index of less than 20 kg/m2. In addition to lifestyle interventions, bisphosphonates (BPs) and denosumab can be offered for prevention and therapy of therapy-induced bone loss. Based on a recent meta-analysis by Coleman et al. [3], adjuvant BPs are associated with reduced breast cancer mortality and recurrence in postmenopausal women. Therefore, BPs including clodronate and aminobisphosphonates may be offered to improve clinical outcome in postmenopausal patients (LoE 1a/A/ AGO +). For denosumab, first survival data of the ABCSG-18 trial involving more than 3,400 postmenopausal patients were presented at the SABCS 2015 [4]. The primary study aim of the ABCSG-18 trial was to measure the time from randomization to first clinical fracture in those receiving denosumab versus those receiving the placebo. Compared with the placebo group, patients in the denosumab group had a significantly delayed time to first clinical fracture (hazard ratio (HR) 0.50, 95% confidence interval (CI) 0.39– 0.65), p < 0.0001). Secondary endpoint of this study was diseaserelated outcome. At a median follow-up of 4 years, denosumab was