ESMO 2025 | De-escalating bone modifying agents

Terry Ng • 18 Oct 2025

ESMO 2025

General

REaCT-Hold BMA

Terry Ng, MD, University of Ottawa, Ottawa, Canada, discusses the clinical or biological factors that might help identify patients who can safely de-escalate or discontinue bone modifying agents, noting that this question remains to be explored and was not specifically addressed in the Phase IV REaCT-Hold BMA trial (NCT04549207). Dr Ng mentions that the study did not pre-stratify cohorts based on burden of bone metastases, but notes that about 35% of patients in both arms had visceral metastases, which is an adverse prognostic factor. This interview took place at the European Society for Medical Oncology (ESMO) 2025 Congress in Berlin, Germany.

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Transcript

I think that question remains to be explored. React-Hold BMA was not specifically designed to look at that. We did not pre-stratify our cohorts based on burden of bone metastases, for example. About 35% in both arms had visceral metastases, which we know is an adverse prognostic factor. So I think it would be considered safe even if patients had visceral metastases, for example.

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