The monoclonal antibody denosumab, which reduces the incidence of skeletal-related events in persons with bone metastases from solid tumors, was recently shown to improve overall survival in persons with metastatic lung cancer more effectively than did zoledronic acid.

In the randomized study yielding this finding, 411 persons with lung cancer and bone metastases were assigned to receive a monthly subcutaneous 120-mg injection of denosumab plus intravenous infusion of a placebo. An additional 400 persons, also with lung cancer and bone metastases, were assigned to receive a monthly 4-mg infusion of zoledronic acid with a subcutaneous placebo injection.

Denosumab was associated with improved median overall survival compared with zoledronic acid: 8.9 months vs 7.7 months. In the subset of 702 patients with non-small cell lung cancer (NSCLC), those on the denosumab regimen also had greater median survival than did those taking zoledronic acid (9.5 months vs 8 months).

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Denosumab triumphed again in patients with squamous cell carcinoma NSCLC, conferring a median survival of 8.6 months compared with 6.4 months for zoledronic acid. Patients with small cell lung cancer (SCLC) also fared better in terms of median survival with denosumab (7.6 months) than with zoledronic acid (5.1 months).

As reported in Journal of Thoracic Oncology (2012;7[12]:1823-1829), the incidence of overall adverse events was balanced between treatment groups. Serious adverse events occurred in 66% of the denosumab group compared with 72.9% of the zoledronic acid group. The cumulative incidence of osteonecrosis of the jaw was similar between groups, at 0.7% for denosumab and 0.8% for zoledronic acid. Hypocalcemia rates were higher with denosumab than with zoledronic acid: 8.6% vs 3.8%.