Studies support bisphosphonate use in cancer patients with bone metastases
Two new studies provide evidence for the benefits of using bisphosphonates in cancer patients with metastatic bone disease.
The first, a systematic review of 30 studies, shows that compared with
placebo, bisphosphonates reduce the risk of fractures, hypercalcaemia
and the need for radiotherapy in patients with bone metastases.
Patients treated with bisphosphonates had a 35 per cent lower risk for
non-vertebral fractures, a 31 per cent lower risk for vertebral fractures,
a 33 per cent reduction in need for radiotherapy and a 46 per cent lower
risk for hypercalcaemia. Furthermore, the review showed that bisphosphonates
increase the time to first skeletal related event, suggesting they should
be started when bone metastases are diagnosed. “We recommend that
bisphosphonates are continued until no longer clinically relevant,” say
the researchers from the Royal Marsden Hospital in London. They add that
most evidence supports the use of the intravenous aminobisphosphonates
disodium pamidronate and zoledronic acid (Zometa).
The review is published in the BMJ (2003;327:469).
The second trial, published in the Journal of the National Cancer
Institute,
shows that oral sodium clodronate (Bonefos, Loron) might slow the development
of bone metastases and reduce the risk of death in men with advanced
prostate cancer (2003;95:1300). Researchers supported by the Medical
Research Council assigned 311 men who were starting or responding to
hormone therapy for bone metastases to receive either sodium clodronate
or placebo for up to three years.
After five years of follow-up, men treated with the bisphosphonate had
a 21 per cent reduced risk of symptomatic bone progression and a 20 per
cent reduction in death. The findings were not statistically significant
but the researchers suggest several reasons for this, including the small
patient population and the use of an oral rather than intravenous bisphosphonate. |
