Comparative efficacy of bone-modifying agents in the treatment of lung cancer bone metastases: immunotherapy era

Denosumab and bisphosphonates are commonly used in clinical practice for lung cancer patients with bone metastasis to prevent skeletal-related events (SREs). The aim of this study was to evaluate the efficacy of these two bone-modifying agents(BMAs)in advanced lung cancer patients with bone metastasis in the era of immunotherapy. Electronic medical records of advanced lung cancer patients with bone metastasis between January 2020 and March 2023 were retrospectively reviewed. Overall survival (OS), progression-free survival (PFS), and the time to the first occurrence of SRE were calculated using the Kaplan - Meier method and were compared using the log-rank test. Among the 227 included patients, denosumab significantly improved OS by 5.41 months compared with bisphosphonates (27.54 months vs. 22.13 months; hazard ratio (HR): 0.61; p = 0.031). Denosumab also delayed the time to the first occurrence of SRE (undefined vs. 31.64 months; HR: 0.43, p = 0.005) and reduced the incidence of multiple SREs. However, the incidence of hypocalcemia at grade ≥ 3 was higher in the denosumab group than in the bisphosphonate group (8.6% vs. 3.0%). In patients with bone metastatic lung cancer, the efficacy of denosumab was significantly higher than that of bisphosphonate.