# Real-life use of bone-targeting agents for bone metastases in France between 2009 and 2018: Results of the OPTIMOS study

## TL;DR

The study found that fewer than 10% of bone metastasis patients in France received bone-targeting agents, which can reduce complications if started early.

## Contribution

The study provides real-world data on the underuse of bone-targeting agents in France and their effectiveness when initiated early.

## Key findings

- Less than 10% of bone metastasis patients in France received bone-targeting agents.
- Early initiation of bone-targeting agents reduced the risk of a second skeletal-related event by nearly 40%.
- Denosumab and bisphosphonates were the most commonly used bone-targeting agents.

## Abstract

•Bone-targeting agents (bisphosphonates, denosumab) reduce skeletal complications and improve quality of life.•Bone-targeting agents should be initiated in bone metastatic patients (ESMO 2020 guidelines).•In real life, less than 10 % of bone metastatic patients did receive bone-targeting agents in France.•Early initiation (<3 months) of bone-targeting agents effectively reduces skeletal complications.•Bone metastasis management should be improved.

Bone-targeting agents (bisphosphonates, denosumab) reduce skeletal complications and improve quality of life.

Bone-targeting agents should be initiated in bone metastatic patients (ESMO 2020 guidelines).

In real life, less than 10 % of bone metastatic patients did receive bone-targeting agents in France.

Early initiation (<3 months) of bone-targeting agents effectively reduces skeletal complications.

Bone metastasis management should be improved.

To determine the use of bone-targeting agents (BTAs) in clinical practice in France and the occurrence of skeletal-related events (SREs) in cancer patients with bone metastases.

This study analysed data, recorded prospectively in a French National Health Insurance database, for patients who had a first diagnosis of bone metastases between 2009 and 2018.

A total of 6,663 patients were analysed (mean age 69.7 ± 13.2 years, 53.2 % male) corresponding to 2,363 bone metastases only patients and 4,300 patients with SREs at inclusion. The most frequent primary cancers were breast (15.8 %), prostate (13.4 %), lung (12.6 %) and digestive cancer (10.6 %). Six-hundred and twenty-one patients (9.3 %) were treated with BTAs (52.7 % with denosumab). Median [IQR] time between inclusion and BTA initiation was similar with denosumab (3.3 months [1.2–7.9]) and bisphosphonates (3.3 months [1.2–8.7]). Patients with a SRE at inclusion and early BTA initiation (≤3 months) had a significative lower incidence of a second SRE at 12 months than those with late initiation (13.6 % [95 %CI: 8.1–20.4] vs. 21.6 % [14.8–29.2] respectively; p < 0.001).

BTAs are underused in bone metastases patients in France. There is an urgent need to optimise bone metastases management in accordance with ESMO 2020 guidelines.