Forsteo ® (teriparatide)

This information is intended for UK registered healthcare professionals only as a scientific exchange in response to your search for information.For current prescribing information for all Lilly products, including Summaries of Product Characteristics, Patient Information Leaflets and Instructions for Use, please visit: www.medicines.org.uk (England, Scotland, Wales) or www.emcmedicines.com/en-GB/northernireland/ (Northern Ireland).

Use of Forsteo® (Teriparatide) in patients with history of cancer

Before prescribing teriparatide to a patient with a history of cancer, the healthcare professional should consider the type of previous cancer, the risk of bone metastases, and the length of time the patient has been in remission.

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What is the risk of using teriparatide in patients with history of cancer?

Healthcare professionals should carefully weigh the intended benefits of teriparatide versus the theoretical risks in patients with a history of cancer such as

  • the possibility of the presence of micrometastatic tumor cells in the bone marrow even after several years of the patient appearing to be cancer-free, and
  • the potential effect of a high-bone-turnover state on those cells.1

A stimulatory effect of teriparatide on hematopoietic stem cells is also a theoretical concern for patients with a history of hematologic cancers.1

Teriparatide is contraindicated in patients with prior external beam or implant radiation therapy to the skeleton.2

Patients with skeletal malignancies or bone metastases should be excluded from treatment with teriparatide.2

For a full list of contraindications, please refer to the summary of product characteristics of Forsteo.2

What type of cancer is known to metastasize to the bone?

The most common cancers to metastasize to the bone (in decreasing order of frequency) are

  • breast
  • prostate
  • lung
  • colon
  • stomach
  • bladder
  • uterus
  • rectum
  • thyroid, and
  • kidney.3

Additional factors affecting the risk of bone metastasis include

  • TNM classification, and
  • estrogen receptor status in patients with a history of breast cancer.3

Where patients with a history of cancer included in clinical trials?

Patients with a history of cancer were not specifically recruited for any teriparatide clinical trials.4

Exclusion criteria for teriparatide clinical trials included

  • patients with a history of carcinoma in the previous 5 years, or
  • patients currently being evaluated for suspected carcinoma.4

Patients allowed to participate in teriparatide clinical trials included

  • patients who had undergone excision of superficial lesions of the skin (eg, basal cell or squamous cell carcinoma), or
  • patients who had a history of carcinoma in situ of the cervix or uterus.4

References

1Farooki A, Fornier M, Girotra M. Anabolic therapies for osteoporosis. N Engl J Med. 2007;357(23):2410-2411. http://dx.doi.org/10.1056/NEJMc076405

2Forsteo [summary of product characteristics]. Eli Lilly Nederland B.V., The Netherlands.

3File E, Deal C. Clinical update on teriparatide. Curr Rheumatol Rep. 2009;11(3):169-176. https://doi.org/10.1007/s11926-009-0023-3

4Data on file, Eli Lilly and Company and/or one of its subsidiaries.

Date of Last Review: 12 November 2020


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