TITLE

The Clinical and Cost Considerations of Bisphosphonates in Preventing Bone Complications in Patients with Metastatic Breast Cancer or Multiple Myeloma

AUTHOR(S)
McCloskey, E.V.; Guest, J.F.; Kanis, J.A.
PUB. DATE
July 2001
SOURCE
Drugs;Jul2001, Vol. 61 Issue 9, p1253
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
The bisphosphonates are potent inhibitors of osteoclast-mediated bone resorption and are now the treatment of choice for the management of hypercalcaemia of malignancy. The incidences of hypercalcaemia and other skeletal complications (bone pain, pathological fracture) remain high despite apparent responses to systemic therapy, with particularly high event rates in women with advanced skeletal metastases of breast cancer. This review focuses on studies addressing the long-term efficacy of bisphosphonates to reduce skeletal complications in breast cancer (5 studies) and multiple myeloma (4 studies), with particular reference to controlled studies of sufficient magnitude and duration to allow confidence in the estimation of efficacy. Bearing in mind the limitations of differences in trial design and the lack of direct studies comparing drugs, adequate exposure to a bisphosphonate reduces the incidence of skeletal complication by 30 to 40% in both breast cancer and multiple myeloma. Oral clondronate and intravenous pamidronate have similar efficacy in both diseases, but the duration of efficacy may differ between drugs. Both agents have shown intriguing survival benefits in subgroups of patients. The numbers needed to treat (NNT) to prevent a skeletal complication during one year are lowest in metastatic skeletal disease in breast cancer (NNT < 8) but also compare very favourably with other disease for patients with recurrent nonskeletal breast cancer or multiple myeloma (NNTs 7 to 31 depending on the complication to be prevented). Treatment costs of both breast cancer and multiple myloma are driven by inpatient and outpatient hospital visits so that bisphosphonate regimens should be developed that reduce both. Further research is required to determine if subgroups of patients can be better identified that will derive particular benefit, or perhaps no benefit at all, from bisphosphonate therapy. It is not known whether more potent bisphosphonates will deliver greater clinical efficacy in the future.
ACCESSION #
4886166

 

Related Articles

  • From the Editor-in-Chief. Brandi, Maria Luisa // Clinical Cases in Mineral & Bone Metabolism;2011, Vol. 8 Issue 1, p5 

    An introduction to articles published within the issue is presented, including one by Francesca Giusti et al on a database for the evaluation and the clinical management of patients with breast cancer treated with antiestrogens and/or aromatase inhibitors, another by Giuseppe Guglielmi et al on...

  • Bisphosphonate treatment did not benefit women with chemoresistant breast cancer. Altersitz, Katrina; Todak, Alexandra // Hem/Onc Today;1/25/2014, Vol. 15 Issue 2, p28 

    The article discusses a phase 3 Neo-Adjuvant Trial Add-On (NATAN) study led by Gunter von Minckwitz, which suggests that biphosphonate treatment did not confer any benefit to postmenopausal women with chemoresistant breast cancer.

  • ASCO Updates Guidelines for Bisphosphonates in Breast Cancer. Wang, Linda // JNCI: Journal of the National Cancer Institute;12/3/2003, Vol. 95 Issue 23, p1743 

    Reports that the American Society of Clinical Oncology has updated its 2000 guidelines for the use of bisphosphonates in women with metastatic breast cancer. Provision of recommendations on safety and adverse effects of the two bisphosphonates, pamidronate and zoledronic acid; Release of a...

  • The use of bisphosphonates in multiple myeloma: recommendations of an expert panel on behalf of the European Myeloma Network. Terpos, E.; Sezer, O.; Croucher, P. I.; García-Sanz, R.; Boccadoro, M.; San Miguel, J.; Ashcroft, J.; Bladé, J.; Cavo, M.; Delforge, M.; Dimopoulos, M.-A.; Facon, T.; Macro, M.; Waage, A.; Sonneveld, P. // Annals of Oncology;Aug2009, Vol. 20 Issue 8, p1303 

    Background: Bisphosphonates (BPs) prevent, reduce, and delay multiple myeloma (MM)-related skeletal complications. Intravenous pamidronate and zoledronic acid, and oral clodronate are used for the management of MM bone disease. The purpose of this paper is to review the current evidence for the...

  • Reduction of osteonecrosis of the jaw (ONJ) after implementation of preventive measures in patients with multiple myeloma treated with zoledronic acid. M. A. Dimopoulos; E. Kastritis; C. Bamia; I. Melakopoulos; D. Gika; M. Roussou; M. Migkou; E. Eleftherakis-Papaiakovou; D. Christoulas; E. Terpos; A. Bamias // Annals of Oncology;Jan2009, Vol. 20 Issue 1, p117 

    Background: Osteonecrosis of the jaw (ONJ) is a well-described complication of bisphosphonates use in patients with multiple myeloma (MM). We investigated whether the occurrence of ONJ decreased after the implementation of preventive measures in 128 patients with MM who received zoledronic acid....

  • Percutaneus osteoplasty in the treatment of extraspinal painful multiple myeloma lesions. Masala, Salvatore; Volpi, Tommaso; Fucci, Francesco P. M.; Cantonetti, Maria; Postorino, Massimiliano; Simonetti, Giovanni // Supportive Care in Cancer;Jul2011, Vol. 19 Issue 7, p957 

    Purpose: The aim of our study was to assess the efficacy and safety of percutaneous osteoplasty (PO), a technical extension of percutaneous vertebroplasty, in the treatment of extraspinal bone lesions from multiple myeloma causing pain resistant to NSAID therapy or treated with opioids. Methods:...

  • NEOPLASMS.  // MPR - Residents' Edition;Spring/Summer2010, Vol. 19 Issue 1, p165 

    The article offers information on several pharmaceutical products for various types of cancer. Afinitor from Novartis AG is a kind of mTOR kinase inhibitor drug used in treating advanced renal cell carcinoma. Alkeran from GlaxoSmithKline is used in mitigating multiple myeloma and epithelial...

  • NEOPLASMS.  // MPR - Long Term Care Edition;May2009, Vol. 4 Issue 1, p153 

    The article offers information on the different drugs for neoplasm in the U.S. It emphasizes the need for full familiarization with cancer chemotherapy before using any of the preparations. The drugs listed here include Aromasin for breast cancer, Casodex for prostate carcinoma and...

  • 12th International Conference on Cancer-Induced Bone Disease. Edwards, Claire M // IBMS BoneKEy;Apr2013, Vol. 10 Issue 4, p312 

    Information about the 12th International Conference on Cancer-Induced Bone Disease held in Lyon, France form November 15-17, 2012 is presented. The topics discussed at the conference include the interactions between pre-metastatic niches and cancer stem cells, the development of bone metastases...

Share

Read the Article

Courtesy of THE LIBRARY OF VIRGINIA

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics