1
|
de Roij van Zuijdewijn C, van Dorp W, Florquin S, Roelofs J, Verburgh K. Bisphosphonate nephropathy: A case series and review of the literature. Br J Clin Pharmacol 2021; 87:3485-3491. [PMID: 33595131 PMCID: PMC8451932 DOI: 10.1111/bcp.14780] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 02/03/2021] [Accepted: 02/05/2021] [Indexed: 11/29/2022] Open
Abstract
From rat studies, human case reports and cohort studies, bisphosphonates seem to impair renal function. However, when critically reviewing the literature, zoledronate and pamidronate are more frequently involved in renal deterioration than other bisphosphonates. When bisphosphonate nephropathy occurs, zoledronate more frequently induces tubular toxicity whereas pamidronate typically induces focal segmental glomerulosclerosis. Thus, although bisphosphonates are highly effective in preventing complications for patients with osseous metastases and are highly effective in preventing fractures for patients with osteoporosis, renal function should be monitored closely after initiation of these drugs.
Collapse
Affiliation(s)
- Camiel de Roij van Zuijdewijn
- Department of Internal Medicine, Spaarne Gasthuis, Haarlem/Hoofddorp, the Netherlands.,Department of Nephrology & Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Wim van Dorp
- Department of Internal Medicine, Spaarne Gasthuis, Haarlem/Hoofddorp, the Netherlands
| | - Sandrine Florquin
- Department of Pathology & Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Joris Roelofs
- Department of Pathology & Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Kees Verburgh
- Department of Internal Medicine, Spaarne Gasthuis, Haarlem/Hoofddorp, the Netherlands
| |
Collapse
|
2
|
Brouns AJWM, De Bie BH, van den Beuken-van Everdingen MHJ, Dingemans AMC, Hendriks LEL. Non-Radiation Based Early Pain Relief Treatment Options for Patients With Non-Small Cell Lung Cancer and Cancer Induced Bone Pain: A Systematic Review. Front Oncol 2020; 10:509297. [PMID: 33194576 PMCID: PMC7642688 DOI: 10.3389/fonc.2020.509297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 09/30/2020] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Cancer induced bone pain (CIBP) is frequent in patients with non-small cell lung cancer (NSCLC). Radiation therapy continues to be the gold standard for treatment of painful bone metastases, however only a limited number of metastases can be irradiated. We evaluated non-radiation based early CIBP relief options in NSCLC through a systematic review. METHODS Systematic review including all prospective articles published between 01-1994 and 06-2020 on Pubmed, Cochrane Library and ClinicalTrials.gov database. Inclusion: non-radiation based trials evaluating CIBP early pain relief options (initially defined as pain score evaluated within two weeks, because of no randomized trials, later inclusion broadened to pain score evaluated within six weeks) in ≥10 NSCLC patients. Radioisotope trials were excluded as these treatments have interactions with systemic anticancer therapy. RESULTS 188 articles were found; 10 articles (6 randomized controlled (4 double blinded), 1 phase II single-arm, and 3 prospective trials) fulfilled the inclusion criteria. Six of these trials consisted of ≥2 treatment arms, whereas the others were single-arm studies. In total, 554 NSCLC patients were evaluated in these trials. The included trials were very heterogeneous regarding evaluated treatment options, methods of pain measuring, and endpoints. No high-level evidence for specific early pain relief treatment options was found. DISCUSSION Non-radiation based studies evaluating treatment options to rapidly reduce CIBP in NSCLC are scarce. This systematic review shows that there is no high-level evidence to recommend a specific treatment for early pain relief. Future research should focus on early pain relief treatment options for CIBP in NSCLC.
Collapse
Affiliation(s)
- Anita J. W. M. Brouns
- Department of Pulmonary Diseases, Zuyderland Medical Center, Sittard-Geleen, Netherlands
- Department of Pulmonary Diseases, GROW—School for Oncology and Developmental Biology, Maastricht University Medical Center+ (MUMC+), Maastricht, Netherlands
| | - Ben H. De Bie
- Department of Anesthesiology, Maastricht University Medical Center+ (MUMC+), Maastricht, Netherlands
| | | | - Anne-Marie C. Dingemans
- Department of Pulmonary Diseases, GROW—School for Oncology and Developmental Biology, Maastricht University Medical Center+ (MUMC+), Maastricht, Netherlands
- Department of Pulmonary Diseases, Erasmus MC, Rotterdam, Netherlands
| | - Lizza E. L. Hendriks
- Department of Pulmonary Diseases, GROW—School for Oncology and Developmental Biology, Maastricht University Medical Center+ (MUMC+), Maastricht, Netherlands
| |
Collapse
|
3
|
Brouns AJWM, Hendriks LEL, van der Noort V, van de Borne BEEM, Schramel FMNH, Groen HJM, Biesma B, Smit HJM, Dingemans AMC. Efficacy of Ibandronate Loading Dose on Rapid Pain Relief in Patients With Non-Small Cell Lung Cancer and Cancer Induced Bone Pain: The NVALT-9 Trial. Front Oncol 2020; 10:890. [PMID: 32670872 PMCID: PMC7326766 DOI: 10.3389/fonc.2020.00890] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 05/06/2020] [Indexed: 12/28/2022] Open
Abstract
Introduction: Approximately 80% of non-small cell lung cancer (NSCLC) patients with bone metastases have cancer induced bone pain (CIBP). Methods: The NVALT-9 was an open-label, single arm, phase II, multicenter study. Main inclusion criterion: bone metastasized NSCLC patients with uncontrolled CIBP [brief pain inventory [BPI] ≥ 5 over last 7 days]. Patients were treated with six milligram ibandronate intravenously (day 1–3) once a day. Main exclusion criteria: active secondary malignancy, systemic anti-tumor treatment and radiotherapy ≤4 weeks before study start, previous bisphosphonate treatment. Statistics: Simon's Optimal two-stage design with a 90% power to declare the treatment active if the pain response rate is ≥ 80% and 95% confidence to declare the treatment inactive if the pain response rate is ≤ 60%. If pain response is observed in ≤ 12 of the first 19 patients further enrollment will be stopped. Primary endpoint: bone pain response, defined as 25% decrease in worst pain score (PSc) over a 3-day period (day 5–7) compared to baseline PSc with maximum of 25% increase in mean analgesic consumption during the same period. Secondary endpoints: BPI score, quality of life, toxicity and World Health Organization Performance Score. Results: Of the 19 enrolled patients in the first stage, 18 were evaluable for response. All completed ibandronate treatment according to protocol. In 4 (22.2%), a bone pain response was observed. According to the stopping rule, further enrollment was halted. Discussion: Ibandronate loading doses lead to insufficient pain relief in NSCLC patients with CIBP.
Collapse
Affiliation(s)
- Anita J W M Brouns
- Department of Pulmonary Diseases, Zuyderland Medical Center, Sittard-Geleen, Netherlands.,Department of Pulmonary Diseases, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center+ (MUMC+), Maastricht, Netherlands
| | - Lizza E L Hendriks
- Department of Pulmonary Diseases, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center+ (MUMC+), Maastricht, Netherlands
| | | | | | | | - Harry J M Groen
- Department of Pulmonary Diseases, University Medical Center Groningen, Groningen, Netherlands
| | - Bonne Biesma
- Department of Pulmonary Diseases, Jeroen Bosch Hospital, 's-Hertogenbosch, Netherlands
| | - Hans J M Smit
- Department of Pulmonary Diseases, Rijnstate Hospital, Arnhem, Netherlands
| | - Anne-Marie C Dingemans
- Department of Pulmonary Diseases, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center+ (MUMC+), Maastricht, Netherlands.,Department of Pulmonary Diseases, Erasmus MC, Rotterdam, Netherlands
| |
Collapse
|
4
|
Xu Q, Zhang S, Zhao Y, Feng Y, Liu L, Cai L, Zhang W, Huang Z, Wei H, Zhuo L, Chen Y. Radiolabeling, quality control, biodistribution, and imaging studies of 177
Lu-ibandronate. J Labelled Comp Radiopharm 2018; 62:43-51. [PMID: 30426535 DOI: 10.1002/jlcr.3694] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 10/23/2018] [Accepted: 11/06/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Qin Xu
- Department of Nuclear Medicine; Affiliated Hospital of Southwest Medical University; Luzhou China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province; Luzhou China
| | - Shumao Zhang
- Department of Nuclear Medicine; Affiliated Hospital of Southwest Medical University; Luzhou China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province; Luzhou China
| | - Yan Zhao
- Department of Nuclear Medicine; Affiliated Hospital of Southwest Medical University; Luzhou China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province; Luzhou China
| | - Yue Feng
- Department of Nuclear Medicine; Affiliated Hospital of Southwest Medical University; Luzhou China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province; Luzhou China
| | - Lin Liu
- Department of Nuclear Medicine; Affiliated Hospital of Southwest Medical University; Luzhou China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province; Luzhou China
| | - Liang Cai
- Department of Nuclear Medicine; Affiliated Hospital of Southwest Medical University; Luzhou China
- State Key laboratory of Quality Research in Chinese Medicine/Macau Institute for Applied Research in Medicine and Health; Macau University of Science and Technology; Taipa Macau SAR PR China
| | - Wei Zhang
- Department of Nuclear Medicine; Affiliated Hospital of Southwest Medical University; Luzhou China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province; Luzhou China
| | - Zhanwen Huang
- Department of Nuclear Medicine; Affiliated Hospital of Southwest Medical University; Luzhou China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province; Luzhou China
| | - Hongyuan Wei
- Isotope Technology and Application Laboratory; Institute of Nuclear Physics and Chemistry, China Academy of Engineering Physics; Mianyang PR China
- Key Laboratory of Nuclear Medicine and Molecular Imaging of Sichuan Province; Mianyang China
| | - Liangang Zhuo
- Isotope Technology and Application Laboratory; Institute of Nuclear Physics and Chemistry, China Academy of Engineering Physics; Mianyang PR China
- Key Laboratory of Nuclear Medicine and Molecular Imaging of Sichuan Province; Mianyang China
| | - Yue Chen
- Department of Nuclear Medicine; Affiliated Hospital of Southwest Medical University; Luzhou China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province; Luzhou China
| |
Collapse
|
5
|
HDAC inhibitor TSA ameliorates mechanical hypersensitivity and potentiates analgesic effect of morphine in a rat model of bone cancer pain by restoring μ-opioid receptor in spinal cord. Brain Res 2017; 1669:97-105. [DOI: 10.1016/j.brainres.2017.05.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 05/12/2017] [Accepted: 05/13/2017] [Indexed: 01/09/2023]
|
6
|
Neuron-restrictive silencer factor-mediated downregulation of μ-opioid receptor contributes to the reduced morphine analgesia in bone cancer pain. Pain 2017; 158:879-890. [PMID: 28415063 PMCID: PMC5402709 DOI: 10.1097/j.pain.0000000000000848] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Neuron-restrictive silencer factor–induced downregulation of μ-opioid receptor is involved in the reduction of morphine analgesia in sarcoma-induced bone cancer pain. Bone cancer pain has been reported to have unique mechanisms and is resistant to morphine treatment. Recent studies have indicated that neuron-restrictive silencer factor (NRSF) plays a crucial role in modulating the expression of the μ-opioid receptor (MOR) gene. The present study elucidates the regulatory mechanisms of MOR and its ability to affect bone cancer pain. Using a sarcoma-inoculated murine model, pain behaviors that represent continuous or breakthrough pain were evaluated. Expression of NRSF in the dorsal root ganglion (DRG) and spinal dorsal horn was quantified at the transcriptional and translational levels, respectively. Additionally, chromatin immunoprecipitation assays were used to detect NRSF binding to the promoter of MOR. Furthermore, NRSF was genetically knocked out by antisense oligodeoxynucleotide, and the expression of MOR and the effect of morphine were subsequently analyzed. Our results indicated that in a sarcoma murine model, NRSF expression is upregulated in dorsal root ganglion neurons, and the expression of NRSF mRNA is significantly negatively correlated with MOR mRNA expression. Additionally, chromatin immunoprecipitation analysis revealed that NRSF binding to the neuron-restrictive silencer element within the promoter area of the MOR gene is promoted with a hypoacetylation state of histone H3 and H4. Furthermore, genetically knocking down NRSF with antisense oligodeoxynucleotide rescued the expression of MOR and potentiated the systemic morphine analgesia. The present results suggest that in sarcoma-induced bone cancer pain, NRSF-induced downregulation of MOR is involved in the reduction of morphine analgesia. Epigenetically, up-regulation of MOR could substantially improve the effect of system delivery of morphine.
Collapse
|
7
|
Improving quality of life in patients with advanced cancer: Targeting metastatic bone pain. Eur J Cancer 2017; 71:80-94. [DOI: 10.1016/j.ejca.2016.10.021] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 10/22/2016] [Indexed: 12/17/2022]
|
8
|
Fontanella C, Fanotto V, Rihawi K, Aprile G, Puglisi F. Skeletal metastases from breast cancer: pathogenesis of bone tropism and treatment strategy. Clin Exp Metastasis 2015; 32:819-33. [PMID: 26343511 DOI: 10.1007/s10585-015-9743-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 09/03/2015] [Indexed: 12/17/2022]
Abstract
Breast cancer (BC) is the most common female cancer worldwide with approximately 10 % of new cases metastatic at diagnosis and 20-50 % of patients with early BC who will eventually develop metastatic disease. Bone is the most frequent site of colonisation and the development of skeletal metastases depends on a complex multistep process, from dissemination and survival of malignant cells into circulation to the actual homing and metastases formation inside bone. Disseminated tumor cells (DTCs) can be detected in bone marrow in approximately 30 % of BC patients, likely reflecting the presence of minimal residual disease that would eventually account for subsequent metastatic disease. Patients with bone marrow DTCs have poorer overall survival compared with patients without them. Although bone-only metastatic disease seems to have a rather indolent behavior compared to visceral disease, bone metastases can cause severe and debilitating effects, including pain, spinal cord compression, hypercalcemia and pathologic fractures. Delivering an appropriate treatment is therefore paramount and ideally it should require interdisciplinary care. Multiple options are currently available, from bisphosphonates to new drugs targeting RANK ligand and radiotherapy. In this review we describe the mechanisms underlying bone colonization and provide an update on existing systemic and locoregional treatments for bone metastases.
Collapse
Affiliation(s)
- Caterina Fontanella
- Department of Oncology, University Hospital of Udine, Piazzale S. Maria della Misericordia, 15, 33100, Udine, Italy.
- Department of Medical and Biological Sciences, University of Udine, Udine, Italy.
| | - Valentina Fanotto
- Department of Oncology, University Hospital of Udine, Piazzale S. Maria della Misericordia, 15, 33100, Udine, Italy
- Department of Medical and Biological Sciences, University of Udine, Udine, Italy
| | - Karim Rihawi
- Department of Oncology, University Hospital of Udine, Piazzale S. Maria della Misericordia, 15, 33100, Udine, Italy
- Department of Medical and Biological Sciences, University of Udine, Udine, Italy
| | - Giuseppe Aprile
- Department of Oncology, University Hospital of Udine, Piazzale S. Maria della Misericordia, 15, 33100, Udine, Italy
| | - Fabio Puglisi
- Department of Oncology, University Hospital of Udine, Piazzale S. Maria della Misericordia, 15, 33100, Udine, Italy
- Department of Medical and Biological Sciences, University of Udine, Udine, Italy
| |
Collapse
|
9
|
Ibandronate: The loading dose concept in the treatment of metastatic bone pain. J Bone Oncol 2015; 5:1-4. [PMID: 26998420 PMCID: PMC4782017 DOI: 10.1016/j.jbo.2015.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 11/06/2015] [Accepted: 11/07/2015] [Indexed: 11/24/2022] Open
Abstract
Background/Aim Severe bone pain is experienced by 60–80% of patients with metastatic bone disease, and has a profound impact on quality of life. Therefore, effective pain relief is an important goal in managing metastatic bone disease. Orthopedic surgeons are often challenged with patients presenting with newly diagnosed bone metastases and severe and disabling bone pain. It is important to provide fast and sufficient analgesia. Clinical trials have demonstrated that bisphosphonates reduce effectively and sustained bone pain by approved standard dosage over time. Open label prospective trials have shown that short time high dose i.v. Ibandronate is effective in rapid pain relief in different primary tumors. Patients and methods In 33 patients with metastatic bone pain from newly diagnosed skeletal metastases we utilized the loading-dose concept for intravenous ibandronate (6 mg infused over 1 h on 3 consecutive days). Results In 33 patients loading-dose ibandronate therapy significantly reduced bone pain within the first 5–7 days (VAS day 0: 6–8 vs. day 7: 3–4). Only 3 patients showed no response concerning a distinct pain reduction within the first days of therapy. There was no increase in pain medication. Conclusion This clinical observational study in selected patients with severe metastatic bone pain undergoing an intensive high dosed ibandronate-therapy for a short period demonstrated that loading-dose ibandronate (6 mg i.v., 3 consecutive days) resulted in a reduction of pain within days.
Collapse
|
10
|
Macpherson IR, Bray C, Hopkins C, Hannon RA, Lewsley LA, Ritchie DM, Canney P. Loading dose ibandronate versus standard oral ibandronate in patients with bone metastases from breast cancer. Clin Breast Cancer 2015; 15:117-27. [PMID: 25454689 DOI: 10.1016/j.clbc.2014.09.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 09/25/2014] [Indexed: 11/22/2022]
Abstract
INTRODUCTION In this phase II trial, the efficacy and safety of loading-dose I.V. ibandronate in patients with breast cancer with bone metastases were evaluated. PATIENTS AND METHODS Thirty-four patients were randomized to receive a loading dose of 12 mg I.V. ibandronate on day 1 then oral ibandronate 50 mg daily (arm A), or standard oral therapy of 50 mg ibandronate daily from day 1 (arm B). The primary end point was percentage change in serum C-terminal crosslinking telopeptide of type I collagen (S-CTX) from baseline by day 5 of study. Secondary/exploratory end points included percentage change in other bone turnover markers (N-terminal cross-linking telopeptides of type I collagen [NTX], procollagen type I N propeptide, bone alkaline phosphatase) and change in average bone pain score. RESULTS There was a significantly greater reduction in S-CTX at day 5 in arm A compared with arm B (median difference, 15.82%; P = .005). There was also a significantly greater reduction in urine NTX/creatinine at day 5 (P = .009) and at the end of weeks 1 to 8 (averaged; P = .006). Average bone pain score was lower in arm A at the end of 8 weeks (P = .012). There were no additional adverse events after administration of 12 mg I.V. loading dose of ibandronate. CONCLUSION A 12-mg dose of I.V. ibandronate rapidly reduced markers of bone turnover and can be administered without additional toxicity.
Collapse
Affiliation(s)
- Iain R Macpherson
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Wolfson Wohl Cancer Research Centre, University of Glasgow, United Kingdom
| | - Caroline Bray
- Cancer Research UK, Clinical Trials Unit, University of Glasgow, Glasgow, United Kingdom.
| | - Carol Hopkins
- Cancer Research UK, Clinical Trials Unit, University of Glasgow, Glasgow, United Kingdom
| | - Rosemary A Hannon
- Academic Unit of Bone Metabolism, University of Sheffield Clinical Sciences Centre, Sheffield, United Kingdom
| | - Liz-Anne Lewsley
- Cancer Research UK, Clinical Trials Unit, University of Glasgow, Glasgow, United Kingdom
| | - Diana M Ritchie
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Peter Canney
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom.
| |
Collapse
|
11
|
Traitements inhibiteurs de la résorption osseuse en situation métastatique : bilan actuel et perspectives. ONCOLOGIE 2015. [DOI: 10.1007/s10269-015-2494-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
12
|
Patient-reported outcome instruments used to assess pain and functioning in studies of bisphosphonate treatment for bone metastases. Support Care Cancer 2012; 20:657-77. [PMID: 22302082 PMCID: PMC3297753 DOI: 10.1007/s00520-011-1356-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2010] [Accepted: 12/12/2011] [Indexed: 01/22/2023]
Abstract
Purpose When treating metastatic bone disease, relief of bone pain is often a key outcome. Because pain cannot be quantified with objective clinical measures, patient-reported outcome (PRO) measures are required to assess patients' subjective experience. The goal of the current review was to examine measures used to assess pain, as well as the impact of pain on functional status and health-related quality of life (HRQL), in trials of bisphosphonates for the treatment of bone metastases. Methods A literature search focused on articles published from January 1999 to April 2009. Results A total of 49 articles were located that used PROs to assess pain-related outcomes of bisphosphonate treatment for bone metastases. The Brief Pain Inventory was the most commonly used multi-item instrument. However, the most common approach for assessing pain was to administer a single-item scale such as a visual analog scale, numerical rating scale, or verbal rating scale. Of the 49 studies, 19 included a PRO assessing functional status or HRQL. Conclusions Although pain is an important outcome of trials examining treatment for bone metastases, the current review suggests that there is little consistency in PRO measurement across studies. Furthermore, presentation of measures often lacked clear description, information on measurement properties, citations, clarity regarding method of administration, and consistent instrument names. Recommendations are provided for instrument validation within the target population, assessment of content validity, use of PRO instruments recently developed for patients with bone metastases, clear description of instruments, and implementation of measures consistent with recommendations from instrument developers.
Collapse
|
13
|
Altundag K, Dizdar O, Ozsaran Z, Ozkok S, Saip P, Eralp Y, Komurcu S, Kuzhan O, Ozguroglu M, Karahoca M. Phase II study of loading-dose ibandronate treatment in patients with breast cancer and bone metastases suffering from moderate to severe pain. ACTA ACUST UNITED AC 2012; 35:254-8. [PMID: 22868504 DOI: 10.1159/000338369] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The aim of this study was to determine the efficacy and safety of loading-dose intravenous (i.v.) ibandronate in women with breast cancer and bone metastases. PATIENTS AND METHODS In this prospective, phase II, open-label study, 13 women with breast cancer, bone metastases, and moderate/severe bone pain received ibandronate 6 mg/day (i.v. loading-dose 15 min infusion over 3 consecutive days) with follow-up until day 14. Endpoints included pain response (primary), duration until pain response, analgesic use, Karnofsky index, safety (including hematologic, biochemical, and urine examinations), and adverse events. RESULTS Pain intensity decreased on days 7 and 14 versus day 1 (mean visual analogue scale score: 3.2 ± 2.2 and 3.0 ± 2.1 versus 6.1 ± 0.9, respectively; p < 0.01 for both). Mean time to pain response was 8.2 ± 3.3 days. Mean rate of analgesic use decreased (69.2%, 16.7% and 15.4% on days 1, 7 and 14, respectively). Mean Karnofsky index score increased (80.8 ± 13.1 and 80.8 ± 13.2, on days 7 and 14 versus 77.7 ± 11.7 on day 1; p < 0.05 on both days). CONCLUSION Bone pain and analgesic use decreased in women with breast cancer and bone metastases following loading dose i.v. ibandronate which was well-tolerated with no renal safety concerns.
Collapse
Affiliation(s)
- Kadri Altundag
- Medical Oncology Department, Hacettepe University School of Medicine, Sıhhiye, Ankara, Turkey.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
A comparative study of intravenous ibandronate and pamindronate in patients with bone metastases from breast or lung cancer: effect on metastatic bone pain. Am J Ther 2012; 18:340-2. [PMID: 20634675 DOI: 10.1097/mjt.0b013e3181e70c38] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We compared the effects of ibandronate and pamindronate in patients with bone metastases from breast or lung cancer and we found that ibandronate is superior to pamindronate in alleviating pain, improving mobility and quality of life, and reducing bone resorption indices in patients with bone metastases from breast or lung cancer.
Collapse
|
15
|
CB1 and CB2 receptor agonists promote analgesia through synergy in a murine model of tumor pain. Behav Pharmacol 2011; 22:607-16. [PMID: 21610490 DOI: 10.1097/fbp.0b013e3283474a6d] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
In light of the adverse side-effects of opioids, cannabinoid receptor agonists may provide an effective alternative for the treatment of cancer pain. This study examined the potency and efficacy of synthetic CB1 and CB2 receptor agonists in a murine model of tumor pain. Intraplantar injection of the CB1 receptor agonist arachidonylcyclopropylamide (ED(50) of 18.4 μg) reduced tumor-related mechanical hyperalgesia by activation of peripheral CB1 but not CB2 receptors. Similar injection of the CB2 receptor agonist AM1241 (ED50 of 19.5 μg) reduced mechanical hyperalgesia by activation of peripheral CB2 but not CB1 receptors. Both agonists had an efficacy comparable with that of morphine (intraplantar), but their analgesic effects were independent of opioid receptors. Isobolographic analysis of the coinjection of arachidonylcyclopropylamide and AM1241 determined that the CB1 and CB2 receptor agonists interacted synergistically to reduce mechanical hyperalgesia in the tumor-bearing paw. These data extend our previous findings that the peripheral cannabinoid receptors are a promising target for the management of cancer pain and mixed cannabinoid receptor agonists may have a therapeutic advantage over selective agonists.
Collapse
|
16
|
Aapro MS, Coleman RE. Bone health management in patients with breast cancer: current standards and emerging strategies. Breast 2011; 21:8-19. [PMID: 21958673 DOI: 10.1016/j.breast.2011.08.138] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Revised: 08/24/2011] [Accepted: 08/29/2011] [Indexed: 01/22/2023] Open
Abstract
In women who develop bone metastases from breast cancer (BC), interactions between tumor cells and osteoclasts within the bone lead to localized bone destruction and increase the risk of skeletal-related events (SREs). Bisphosphonates inhibit osteoclast-mediated bone resorption, and have been used extensively for treating post-menopausal osteoporosis and reducing the risk of SREs in patients with bone metastases. A number of clinical trials in women with early stage BC have demonstrated that adding bisphosphonates to adjuvant endocrine therapy can prevent bone loss and may prevent disease recurrence and improve disease-free survival. In women with bone metastases from BC, bisphosphonates have demonstrated efficacy for reducing skeletal morbidity and pain and improving quality of life. Recent economic analyses have demonstrated that bisphosphonate therapy is a cost-effective use of healthcare resources. This review summarizes the available data for bisphosphonate benefits in both the adjuvant and metastatic settings in the context of evolving clinical practice.
Collapse
Affiliation(s)
- Matti S Aapro
- Institut Multidisciplinaire d'Oncologie Clinique de Genolier, Switzerland.
| | | |
Collapse
|
17
|
Dixmérias F, Palussière J. [Management of painful bone metastases]. ACTA ACUST UNITED AC 2011; 92:796-800. [PMID: 21944238 DOI: 10.1016/j.jradio.2011.07.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Accepted: 07/21/2011] [Indexed: 11/30/2022]
Abstract
Bone metastases are frequently symptomatic. The pain is specific due to its pathophysiology, characteristics and treatment. Conventional antalgic pain management may be insufficient and management should be multifacetted, global and multidisciplinary. Interventional radiology procedures widen the range of possible antalgic therapies. Their role in the management of patients should be defined by a multidisciplinary team on a case-by-case review, based on the patient's symptoms and fracture risk. Additional scientific validation of the effectiveness of such therapies is needed. Recommendations on the role of interventional radiology procedures in the management of patients with symptomatic bone metastases are needed to standardize the different practices and increase the role of interventional radiology in the management of symptomatic bone metastases at the national level. Implementation of the cancer 2009-2012 project could facilitate the availability of these therapies to patients with cancer pain.
Collapse
Affiliation(s)
- F Dixmérias
- Unité de traitement des douleurs en cancérologie, département d'anesthésie-réanimation, institut Bergonié, 229, cours de l'Argonne, 33076 Bordeaux cedex, France.
| | | |
Collapse
|
18
|
Petrut B, Trinkaus M, Simmons C, Clemons M. A primer of bone metastases management in breast cancer patients. ACTA ACUST UNITED AC 2011; 15:S50-7. [PMID: 18231649 PMCID: PMC2216426 DOI: 10.3747/co.2008.176] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Bone is the most common site for distant spread of breast cancer. Following a diagnosis of metastatic bone disease, patients can suffer from significant morbidity because of pain and skeletal related events (SRES). Bisphosphonates are potent inhibitors of osteoclastic function and the mainstay of bone-directed therapy for bone metastases. The aims of bisphosphonates are to prevent and delay SRES, to reduce bone pain, and to improve quality of life. Bisphosphonate therapy appears to have revolutionized treatment of bone metastases, but bisphosphonate use has several limitations. Those limitations include the high cost of the agents and the need for return trips to the clinic for intravenous treatment. Moreover, many uncertainties surround bisphosphonate use-for example, the timing of bisphosphonate initiation, the choice of bisphosphonate to use, the optimal duration of treatment, and the appropriate means to identify patients who will and will not benefit. In addition, potentially serious adverse effects have been associated with bisphosphonate use-for example, renal toxicity, gastrointestinal side effects, and osteonecrosis of the jaw. The present review is intended as a primer for oncology specialists who treat patients with bone metastases secondary to breast cancer. It focuses on bisphosphonate treatment guidelines, the evidence for those guidelines, and a discussion of new therapeutic agents. It also discusses the use of biochemical markers of bone metabolism, which show promise for predicting the risk of a patient's developing a SRE and of benefiting from bisphosphonate treatment.
Collapse
Affiliation(s)
| | | | | | - M. Clemons
- Correspondence to: Mark Clemons, Breast Medical Oncology, Princess Margaret Hospital, 610 University Avenue, Toronto, Ontario M5G 2M9. E-mail:
| |
Collapse
|
19
|
Devitt B, McLachlan SA. Use of ibandronate in the prevention of skeletal events in metastatic breast cancer. Ther Clin Risk Manag 2011; 4:453-8. [PMID: 18728841 PMCID: PMC2504065 DOI: 10.2147/tcrm.s1966] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Bone metastasis from breast cancer often cause significant morbidity including pain, impaired mobility, pathological fracture, and spinal cord compression. Bisphosphonates play an important role in preventing these skeletal related events and are the standard of care for patients with bone metastasis from breast cancer. Ibandronate is a highly potent bisphosphonate available in both intravenous and oral preparations. It has been shown in clinical trials to be effective in reducing skeletal complications and also significantly improve quality of life up to 96 weeks. Unlike other intravenous bisphosphonates, ibandronate has minimal renal toxicity, allowing safe outpatient administration, reducing the need for hospital attendance and safety monitoring. Early trials have shown ibandronate may also be effective in high doses for palliation of opioid-resistant pain from bone metastasis, and as a second-line agent in patients developing a skeletal complication whilst receiving another bisphosphonate.
Collapse
Affiliation(s)
- Bianca Devitt
- St Vincent's Hospital Melbourne, Victoria, Australia
| | | |
Collapse
|
20
|
Abstract
Some level of renal dysfunction is common in patients with cancer. This could be a result of an age-related kidney function decrease, the underlying disease (eg, multiple myeloma), or the effects of nephrotoxic medications. Some intravenous (I.V.) bisphosphonates have been associated with occasional renal toxicity in the clinical setting. Therefore, the choice of an I.V. bisphosphonate should take into account the risk of renal deterioration. Preclinical studies also suggest that there might be considerable differences between the renal safety profiles of commonly used I.V. bisphosphonates. Variations in the risk of histopathologic damage and the ability to cause cumulative toxicity have been observed in comparative preclinical studies of I.V. bisphosphonates. The reasons for these apparent differences are not fully understood. Research shows that renal safety profiles might be influenced by pharmacokinetic properties, such as renal tissue half-life, protein binding, and intracellular potency. Preclinical analyses are warranted in order to confirm and evaluate these differences between bisphosphonates.
Collapse
Affiliation(s)
- Jean-Jacques Body
- Department of Internal Medicine, Institut Jules Bordet, Université Libré de Bruxelles, Belgium
| |
Collapse
|
21
|
Pivot X, Lortholary A, Abadie-Lacourtoisie S, Mefti-Lacheraf F, Pujade-Lauraine E, Lefeuvre C, Letessier S, Morvan P, Dür C, Frimat L. Renal safety of ibandronate 6 mg infused over 15 min versus 60 min in breast cancer patients with bone metastases: a randomized open-label equivalence trial. Breast 2011; 20:510-4. [PMID: 21727006 DOI: 10.1016/j.breast.2011.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Revised: 05/15/2011] [Accepted: 05/19/2011] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The aim of this study was to demonstrate the renal safety equivalence of ibandronate 6 mg infused over 15 min versus 60 min, in patients with bone metastases of breast cancer. PATIENTS AND METHODS Patients were females having breast cancer with at least one bone metastasis. Exclusion criteria were renal failure (creatinine clearance < 30 mL/min), tooth/jaw disorder or uncontrolled severe disease. Eligible patients were randomly assigned to receive nine ibandronate 6 mg i.v. infusions over either 15 min or 60 min. The primary outcome was the 95% confidence interval (CI) of the difference in creatinine clearance between groups, 28 days after the last infusion. The equivalence margin was ±8 mL/min. RESULTS Overall 334 patients were randomized (165-15 min infusions vs. 169 to 60 min infusions, 325 (159 vs. 166) were analyzed by intent-to-treat, and 312 (151 vs. 161) were analyzed per protocol. Per protocol, the 15 min-60 min difference in creatinine clearance [95% CI] was -3.00 [-8.18, 2.18]. By intent-to-treat, this difference was-2.91 [-7.99, 2.16]. Death and serious adverse event rates did not differ between groups. Three serious adverse events were considered related to ibandronate: an osteonecrosis of the jaw (15-min group), a pain in jaw and an enamel cracking (60-min group). Two renal failures, reported in the 60 min group, were not considered related to ibandronate. None occurred in the 15 min group. CONCLUSION Ibandronate may be infused over 15 min without clinically significant consequence on renal safety.
Collapse
Affiliation(s)
- Xavier Pivot
- University Hospital Jean Minjoz, 3 bd Alexandre Fleming, 25030 Besançon Cedex, France.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Abstract
Malignant bone disease is common in patients with advanced solid tumors or multiple myeloma. Bisphosphonates have been found to be important treatments for bone metastases. A positive benefit-risk ratio for bisphosphonates has been established, and ongoing clinical trials will determine whether individualized therapy is possible. Bisphosphonates are important treatments for bone metastases. Considerations for optimizing the clinical benefits of bisphosphonates include efficacy, compliance, and safety. Several bisphosphonates are approved for clinical use; however, few have demonstrated broad efficacy in the oncology setting and been compared directly in clinical trials. Among patients with bone metastases from breast cancer, the efficacy of approved bisphosphonates was evaluated in a Cochrane review, showing a reduction in the risk of skeletal-related events (SREs) ranging from 8% to 41% compared with placebo. Between-trial comparisons are confounded by inconsistencies in trial design, SRE definition, and endpoint selection. Zoledronic acid has demonstrated clinical benefits beyond those of pamidronate in a head-to-head trial that included patients with breast cancer or multiple myeloma. Compliance and adherence also have effects on treatment efficacy. In a comparison study, the adherence rates with oral bisphosphonates were found to be significantly lower compared with those of intravenous bisphosphonates. The safety profiles of oral and intravenous bisphosphonates differ. Oral bisphosphonates are associated with gastrointestinal side effects, whereas intravenous bisphosphonates have dose- and infusion rate–dependent effects on renal function. Osteonecrosis of the jaw is an uncommon but serious event in patients receiving monthly intravenous bisphosphonates or denosumab. The incidence of this event can be reduced with careful oral hygiene. A positive benefit-risk ratio for bisphosphonates has been established, and ongoing clinical trials will determine whether individualized therapy is possible.
Collapse
Affiliation(s)
- Matti Aapro
- IMO Clinique de Genolier, CH 1272 Genolier, Switzerland.
| | | | | |
Collapse
|
23
|
Procollagen type I N-propeptide is a predictor of skeletal morbidity in patients with malignant osteolytic bone disease on bisphosphonates. Cancer Chemother Pharmacol 2010; 67:1137-44. [DOI: 10.1007/s00280-010-1420-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2010] [Accepted: 07/20/2010] [Indexed: 11/25/2022]
|
24
|
Haslbauer F, Fiegl M. Bisphosphonates as adjuvant therapy in multimodal pain management. MEMO-MAGAZINE OF EUROPEAN MEDICAL ONCOLOGY 2009. [DOI: 10.1007/s12254-009-0143-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
25
|
Abstract
Approximately 30 to 40% of patients with advanced lung cancer will develop bone metastases in the course of their disease, resulting in a significant negative impact on both morbidity and survival. Skeletal complications of bone metastases include pain, pathologic fractures, spinal cord compression, and hypercalcemia. Total medical care costs are greater among patients with bone metastases who develop skeletal complications. A randomized phase III trial of the third generation bisphosphonate zoledronic acid has shown clinical benefit in the management of a subgroup of patients with bone metastases from lung cancer. Zoledronic acid treatment was associated with a reduction in both the risk of, and time to, a skeletal-related event. One of the markers of bone resorption, N-telopeptide, is both prognositic for development of skeletal-related events and predictive for benefit from zoledronic acid. In preclinical models, bisphosphonates have also demonstrated antitumor activity and are therefore currently being evaluated in adjuvant trials. Inhibition of the receptor activator of nuclear factor kappa B ligand-RANK pathway can reduce osteoclast-mediated bone resorption, and trials comparing receptor activator of nuclear factor kappa B ligand inhibitors with bisphosphonates are ongoing, including patients with lung cancer. In this article, we review the management of bone metastases and hypercalcemia as well as potential future directions for bone directed therapies in patients with lung cancer.
Collapse
|
26
|
Chow E, Hird A, Velikova G, Johnson C, Dewolf L, Bezjak A, Wu J, Shafiq J, Sezer O, Kardamakis D, van der Linden Y, Ma B, Castro M, Arnalot PF, Ahmedzai S, Clemons M, Hoskin P, Yee A, Brundage M, Bottomley A. The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire for patients with Bone Metastases: The EORTC QLQ-BM22. Eur J Cancer 2009; 45:1146-1152. [DOI: 10.1016/j.ejca.2008.11.013] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2008] [Accepted: 11/11/2008] [Indexed: 11/12/2022]
|
27
|
Hald A. Spinal Astrogliosis in Pain Models: Cause and Effects. Cell Mol Neurobiol 2009; 29:609-19. [DOI: 10.1007/s10571-009-9390-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2008] [Accepted: 03/09/2009] [Indexed: 01/25/2023]
|
28
|
Pecherstorfer M. Treatment Options for Breast Cancer and Bone Metastases. WOMENS HEALTH 2009; 5:149-63. [DOI: 10.2217/17455057.5.2.149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The most common destination for breast cancer metastases is bone. If bone metastases are detected, treatment algorithms should include the continuation of cytoreductive therapy with the addition of treatment to counter skeletal-related events, including bone pain. The range of current treatment options includes bisphosphonates, surgical intervention to improve structural integrity and palliative focal radiotherapy. This article focuses on the role of bisphosphonate therapy in metastatic breast cancer. Bisphosphonate therapy significantly reduces the impact of skeletal-related events, reduces bone pain and increases patient quality of life. Our current understanding is that bisphosphonates may also disrupt the metastatic process and reduce the development of bone lesions. Ultimately, this may lead to further expansion of bisphosphonate-based therapy in the future.
Collapse
Affiliation(s)
- Martin Pecherstorfer
- Martin Pecherstorfer, Hematologic–Oncologic Service, Landesklinikum Krems, A-3500 Krems, Austria, Tel.: +43 2732 804 4425, Fax: +43 2732 804 6708,
| |
Collapse
|
29
|
Costa L, Major PP. Effect of bisphosphonates on pain and quality of life in patients with bone metastases. Nat Rev Clin Oncol 2009; 6:163-74. [PMID: 19190592 DOI: 10.1038/ncponc1323] [Citation(s) in RCA: 117] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2008] [Accepted: 09/10/2008] [Indexed: 01/22/2023]
Abstract
Bone is the most common organ for tumor metastasis, especially in patients with cancers of the breast or prostate. Bone metastases disrupt skeletal metabolism and result in considerable skeletal morbidity, including intractable, chronic bone pain, hypercalcemia of malignancy, pathologic fracture and spinal-cord compression. In addition to the chronic pain caused by bone metastases, skeletal-related events (SREs) such as pathologic fractures and spinal-cord compression can result in acute increases in pain. These effects can severely impair mobility and contribute to a general decrease in quality of life. Palliative options to treat bone metastases include radiotherapy, analgesics, surgery and bisphosphonates. These drugs bind to the surface of the bone and impair osteoclast-mediated bone resorption, and reduce the tumor-associated osteolysis that is initiated by the development of skeletal metastases. In addition to preventing SREs, bisphosphonates can palliate bone pain caused by a variety of solid tumors. This Review summarizes the clinical trial data of bisphosphonates for the prevention of SREs and the palliation of bone pain. Among these agents, nitrogen-containing bisphosphonates are recognized as the most effective, and zoledronic acid has demonstrated the broadest clinical utility.
Collapse
Affiliation(s)
- Luis Costa
- Serviço de Oncologia, Hospital de Santa Maria, Instituto de Medicina Molecular, Lisboa, Lisbon, Portugal.
| | | |
Collapse
|
30
|
Statistical Validation of the Relationships of Cancer Pain Relief With Various Factors Using Ordered Logistic Regression Analysis. Clin J Pain 2009; 25:65-72. [DOI: 10.1097/ajp.0b013e31817e1379] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
31
|
Diel IJ, Weide R, Köppler H, Antràs L, Smith M, Green J, Wintfeld N, Neary M, Duh MS. Risk of renal impairment after treatment with ibandronate versus zoledronic acid: a retrospective medical records review. Support Care Cancer 2008; 17:719-25. [PMID: 19089462 DOI: 10.1007/s00520-008-0553-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2008] [Accepted: 11/24/2008] [Indexed: 11/27/2022]
Abstract
PURPOSE This retrospective study compared renal impairment rates in breast cancer, multiple myeloma, prostate cancer and non-small cell lung cancer patients treated with ibandronate or zoledronic acid. STUDY DESIGN Medical records in two German oncology clinics from May 2001 to March 2006 were retrospectively reviewed. Creatinine measurements were analyzed from baseline (before bisphosphonate treatment) to last available measurement for each patient. The Cox proportional hazards model and the Andersen-Gill extension of the Cox model for multiple events analysis were used for multivariate analysis, which controlled for age, clinic site, primary cancer type, baseline SCr or GFR value, prior bisphosphonate use, concomitant use of drugs associated with acute renal failure, and renal-related comorbidities. RESULTS Of 333 patients, 109 received ibandronate and 256 received zoledronic acid (32 patients had both drugs). Compared with ibandronate, the zoledronic acid group had a significantly better baseline renal function and fewer patients had a history of renal disease. Zoledronic acid treatment increased the relative risk (RR) and the incidence rate (IR) of renal impairment by approximately 1.5-fold in all assessed patients (all tumors) compared with ibandronate. Multivariate analysis found significantly higher hazards ratios for zoledronic acid over ibandronate (two to sixfold), after adjusting for differences in characteristics between the two treatment groups. CONCLUSIONS In this retrospective review, patients were significantly more likely to experience renal impairment with zoledronic acid than with ibandronate.
Collapse
Affiliation(s)
- Ingo J Diel
- Centrum für ganzheitliche Gynäkologie, Mannheim, Germany
| | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Ratanatharathorn V, Peñagarícano JA. Management of Bone Metastases. Radiat Oncol 2008. [DOI: 10.1007/978-3-540-77385-6_43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
33
|
A decrease in anandamide signaling contributes to the maintenance of cutaneous mechanical hyperalgesia in a model of bone cancer pain. J Neurosci 2008; 28:11141-52. [PMID: 18971457 DOI: 10.1523/jneurosci.2847-08.2008] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Tumors in bone are associated with pain in humans. Data generated in a murine model of bone cancer pain suggest that a disturbance of local endocannabinoid signaling contributes to the pain. When tumors formed after injection of osteolytic fibrosarcoma cells into the calcaneus bone of mice, cutaneous mechanical hyperalgesia was associated with a decrease in the level of anandamide (AEA) in plantar paw skin ipsilateral to tumors. The decrease in AEA occurred in conjunction with increased degradation of AEA by fatty acid amide hydrolase (FAAH). Intraplantar injection of AEA reduced the hyperalgesia, and intraplantar injection of URB597, an inhibitor of FAAH, increased the local level of AEA and also reduced hyperalgesia. An increase in FAAH mRNA and enzyme activity in dorsal root ganglia (DRG) L3-L5 ipsilateral to the affected paw suggests DRG neurons contribute to the increased FAAH activity in skin in tumor-bearing mice. Importantly, the anti-hyperalgesic effects of AEA and URB597 were blocked by a CB1 receptor antagonist. Increased expression of CB1 receptors by DRG neurons ipsilateral to tumor-bearing limbs may contribute to the anti-hyperalgesic effect of elevated AEA levels. Furthermore, CB1 receptor protein-immunoreactivity as well as inhibitory effects of AEA and URB597 on the depolarization-evoked Ca(2+) transient were increased in small DRG neurons cocultured with fibrosarcoma cells indicating that fibrosarcoma cells are sufficient to evoke phenotypic changes in AEA signaling in DRG neurons. Together, the data provide evidence that manipulation of peripheral endocannabinoid signaling is a promising strategy for the management of bone cancer pain.
Collapse
|
34
|
Pecherstorfer M. Managing neoplastic bone disease with ibandronic acid: a preclinical and clinical data update. Expert Opin Pharmacother 2008; 9:3111-9. [DOI: 10.1517/14656560802482945] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
35
|
Roato I, D'Amelio P, Gorassini E, Grimaldi A, Bonello L, Fiori C, Delsedime L, Tizzani A, De Libero A, Isaia G, Ferracini R. Osteoclasts are active in bone forming metastases of prostate cancer patients. PLoS One 2008; 3:e3627. [PMID: 18978943 PMCID: PMC2574033 DOI: 10.1371/journal.pone.0003627] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2008] [Accepted: 10/15/2008] [Indexed: 11/18/2022] Open
Abstract
Background Bone forming metastases are a common and disabling consequence of prostate cancer (CaP). The potential role of osteoclast activity in CaP bone metastases is not completely explained. In this study, we investigated ex vivo whether the osteolytic activity is present and how it is ruled in CaP patients with bone forming metastases. Methodology Forty-six patients affected by newly diagnosed CaP and healthy controls were enrolled. At diagnosis, 37 patients had a primary tumour only, while 9 had primary tumour and concomitant bone forming metastases. In all patients there was no evidence of metastasis to other non-bone sites. For all patients and controls we collected blood and urinary samples. We evaluated patients' bone homeostasis; we made peripheral blood mononuclear cell (PBMC) cultures to detect in vitro osteoclastogenesis; we dosed serum expression of molecules involved in cancer induced osteoclatogenesis, such as RANKL, OPG, TNF-alpha, DKK-1 and IL-7. By Real-Time PCR, we quantified DKK-1 and IL-7 gene expression on micro-dissected tumour and healthy tissue sections. Principal Findings CaP bone metastatic patients showed bone metabolism disruption with increased bone resorption and formation compared to non-bone metastatic patients and healthy controls. The CaP PBMC cultures showed an enhanced osteoclastogenesis in bone metastatic patients, due to an increase of RANKL/OPG ratio. We detected increased DKK-1 serum levels and tissue gene expression in patients compared to controls. IL-7 resulted high in patients' sera, but its tissue gene expression was comparable in patients and controls. Conclusions We demonstrated ex vivo that osteoclastogenesis is an active mechanism in tumour nesting of bone forming metastatic cancer and that serum DKK-1 levels are increased in CaP patients, suggesting to deeply investigate its role as tumour marker.
Collapse
Affiliation(s)
- Ilaria Roato
- CeRMS (Center for Experimental Research and Medical Studies) University and A.O.U. San Giovanni Battista, Turin, Italy.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Tharmalingam S, Chow E, Harris K, Hird A, Sinclair E. Quality of life measurement in bone metastases: A literature review. J Pain Res 2008; 1:49-58. [PMID: 21197288 PMCID: PMC3004617 DOI: 10.2147/jpr.s4572] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Quality of life (QOL) has become an important consideration in the care of patients with bone metastases as prevalence, incidence and patient survival are on the rise. As a result, more interventional studies now measure patient’s QOL as a meaningful endpoint. However, well-developed bone metastases specific quality of life instruments are lacking. A literature review was conducted to better understand the nature of QOL instruments used in bone metastases trials. A total of 47 articles evaluating QOL in patients with bone metastases were identified. Twenty-five different instruments were used to evaluate QOL with study-designed questionnaires and the EORTC QLQ-C30 being most commonly employed. Many studies used more than one scale or instrument to measure QOL. This makes it difficult to compare QOL in bone metastases patients across studies and come to any formal conclusions. Therefore, this review demonstrates the need to develop a bone module that can be used across countries in future clinical trials.
Collapse
Affiliation(s)
- Sukirtha Tharmalingam
- Rapid Response Radiotherapy Program, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | | | | | | | | |
Collapse
|
37
|
Abstract
Bisphosphonates are valuable agents for the treatment of post-menopausal osteoporosis (PMO), hypercalcemia of malignancy, and osteolytic bone metastases. Oral bisphosphonates are used mainly to treat PMO and are not associated with significant nephrotoxicity. In contrast, nephrotoxicity is a significant potential limiting factor to the use of intravenous (IV) bisphosphonates, and the nephrotoxicity is both dose-dependent and infusion time-dependent. The two main IV bisphosphonates available to treat hypercalcemia of malignancy and osteolytic bone disease in the United States are zoledronate and pamidronate. Patterns of nephrotoxicity described with these agents include toxic acute tubular necrosis and collapsing focal segmental glomerulosclerosis, respectively. With both of these agents, severe nephrotoxicity can be largely avoided by stringent adherence to guidelines for monitoring serum creatinine prior to each treatment, temporarily withholding therapy in the setting of renal insufficiency, and adjusting doses in patients with pre-existing chronic kidney disease. In patients with PMO, zoledronate and pamidronate are associated with significantly less nephrotoxicity, which undoubtedly relates to the lower doses and longer dosing intervals employed for this indication. Ibandronate is approved in the US for treatment of PMO and in Europe for treatment of PMO and malignancy-associated bone disease. Available data suggest that ibandronate has a safe renal profile without evidence of nephrotoxicity, even in patients with abnormal baseline kidney function.
Collapse
|
38
|
Roato I, Gorassini E, Buffoni L, Lyberis P, Ruffini E, Bonello L, Baldi I, Ciuffreda L, Mussa A, Ferracini R. Spontaneous osteoclastogenesis is a predictive factor for bone metastases from non-small cell lung cancer. Lung Cancer 2008; 61:109-16. [DOI: 10.1016/j.lungcan.2007.10.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2007] [Revised: 10/09/2007] [Accepted: 10/11/2007] [Indexed: 11/26/2022]
|
39
|
Impact of skeletal complications on patients' quality of life, mobility, and functional independence. Support Care Cancer 2008; 16:879-89. [PMID: 18392862 DOI: 10.1007/s00520-008-0418-0] [Citation(s) in RCA: 147] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2007] [Accepted: 01/30/2008] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Skeletal-related events (SREs) from malignant bone disease cause considerable morbidity and can dramatically reduce patients' quality of life. DISCUSSION Pathologic fractures often require surgical intervention and palliative radiotherapy. Thus, patients suffer impaired mobility, loss of functional independence, and diminished health-related quality of life (HRQOL). Bisphosphonates can delay the onset and reduce the incidence of SREs and have become the standard of care for the treatment of malignant bone disease; however, minimal information on the effects of bisphosphonate treatment on HRQOL is available. Targeted HRQOL assessments for patients with malignant bone disease are currently under development and are discussed herein.
Collapse
|
40
|
Olson K, Van Poznak C. Significance and impact of bisphosphonate-induced acute phase responses. J Oncol Pharm Pract 2008; 13:223-9. [PMID: 18045781 DOI: 10.1177/1078155207080806] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Bisphosphonates are synthetic analogs of inorganic pyrophosphates with high avidity for bone, where they bind to hydroxyapatite crystals. Bisphosphonates are effective in decreasing bone resorption, the incidence of skeletal-related events, and pain from bone metastases. These agents have recently become incorporated into the treatment regimen of patients with osteolytic and osteoblastic metastatic bone disease. Although relatively well tolerated, the initial dose(s) of intravenous aminobisphosphonates can be associated with an acute phase response, a nonspecific physiologic reaction associated with increased levels of inflammatory cytokines, fever, and flu like symptoms including fatigue, nausea, and myalgia. OBJECTIVE The purpose of this article is to provide an updated review of the literature in this field. DATA SOURCE A search of PubMed was performed using the key terms bisphosphonate, acute phase response, and cancer, and limited to publications in English. The published literature on acute phase response with bisphosphonate therapy was reviewed. RESULTS AND CONCLUSIONS Approximately 40% of patients receiving aminobisphosphonates experience an acute phase response, which generally occurs only on first exposure to the drug and typically last <72 h. Not all bisphosphonates induce acute phase responses to the same extent. This article reviews acute phase response in patients with metastatic bone disease treated with aminobisphosphonates.
Collapse
Affiliation(s)
- Karin Olson
- University of Michigan Comprehensive Cancer Center
| | | |
Collapse
|
41
|
Aapro M, Abrahamsson PA, Body JJ, Coleman RE, Colomer R, Costa L, Crinò L, Dirix L, Gnant M, Gralow J, Hadji P, Hortobagyi GN, Jonat W, Lipton A, Monnier A, Paterson AHG, Rizzoli R, Saad F, Thürlimann B. Guidance on the use of bisphosphonates in solid tumours: recommendations of an international expert panel. Ann Oncol 2008; 19:420-32. [PMID: 17906299 DOI: 10.1093/annonc/mdm442] [Citation(s) in RCA: 383] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Bisphosphonates (BP) prevent, reduce, and delay cancer-related skeletal complications in patients, and have substantially decreased the prevalence of such events since their introduction. Today, a broad range of BP with differences in potency, efficacy, dosing, and administration as well as approved indications is available. In addition, results of clinical trials investigating the efficacy of BP in cancer treatment-induced bone loss (CTIBL) have been recently published. The purpose of this paper is to review the current evidence on the use of BP in solid tumours and provide clinical recommendations. An interdisciplinary expert panel of clinical oncologists and of specialists in metabolic bone diseases assessed the widespread evidence and information on the efficacy of BP in the metastatic and nonmetastatic setting, as well as ongoing research on the adjuvant use of BP. Based on available evidence, the panel recommends amino-bisphosphonates for patients with metastatic bone disease from breast cancer and zoledronic acid for patients with other solid tumours as primary disease. Dosing of BP should follow approved indications with adjustments if necessary. While i.v. administration is most often preferable, oral administration (clodronate, IBA) may be considered for breast cancer patients who cannot or do not need to attend regular hospital care. Early-stage cancer patients at risk of developing CTIBL should be considered for preventative BP treatment. The strongest evidence in this setting is now available for ZOL. Overall, BP are well-tolerated, and most common adverse events are influenza-like syndrome, arthralgia, and when used orally, gastrointestinal symptoms. The dose of BP may need to be adapted to renal function and initial creatinine clearance calculation is mandatory according to the panel for use of any BP. Subsequent monitoring is recommended for ZOL and PAM, as described by the regulatory authority guidelines. Patients scheduled to receive BP (mainly every 3-4 weeks i.v.) should have a dental examination and be advised on appropriate measures for reducing the risk of jaw osteonecrosis. BP are well established as supportive therapy to reduce the frequency and severity of skeletal complications in patients with bone metastases from different cancers.
Collapse
Affiliation(s)
- M Aapro
- Institut Multidisciplinaire d'Oncologie, Clinique de Genolier, Genolier, Switzerland.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Lewiecki EM, Miller PD. Renal safety of intravenous bisphosphonates in the treatment of osteoporosis. Expert Opin Drug Saf 2007; 6:663-72. [PMID: 17967155 DOI: 10.1517/14740338.6.6.663] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Oral bisphosphonates are the mainstay of treatment for osteoporosis but cannot be used in some patients due to gastrointestinal contraindications, gastrointestinal intolerance, malabsorption or the inability to comply with dosing requirements. In such patients, intravenous bisphosphonates are a useful alternative. This review summarises the renal safety issues associated with the use of intravenous bisphosphonates for osteoporosis. Intravenous bisphosphonates are generally well tolerated, which may be a reflection of their selective activity in bone and metabolic stability. Adverse effects on renal function are primarily related to infusion rate and dose. Due to lack of data, no conclusions can be made regarding bisphosphonate safety in patients with intrinsic renal disease or an estimated glomerular filtration rate of < 30 ml/min.
Collapse
Affiliation(s)
- E Michael Lewiecki
- University of New Mexico School of Medicine, Albuquerque, New Mexico, USA.
| | | |
Collapse
|
43
|
Saad F. New research findings on zoledronic acid: survival, pain, and anti-tumour effects. Cancer Treat Rev 2007; 34:183-92. [PMID: 18061356 DOI: 10.1016/j.ctrv.2007.10.002] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2007] [Accepted: 10/15/2007] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To summarize the current evidence for clinical, anti-tumour, and survival benefits from zoledronic acid in patients with genitourinary cancers. METHODS Studies were identified through MEDLINE searches, review of bibliographies of relevant articles, and review of abstracts from scientific meetings. RESULTS Among patients with bone metastases from prostate cancer or renal cell carcinoma, zoledronic acid significantly delayed the onset and reduced the incidence of skeletal complications compared with placebo. Zoledronic acid is also the only bisphosphonate that has demonstrated a trend toward improved survival and delayed progression of bone lesions in patients with urologic malignancies. Furthermore, zoledronic acid reduced the incidence of pathologic fracture, a skeletal-related event known to be associated with reduced survival. Bisphosphonates have also demonstrated significant palliative benefits, and preclinical evidence indicates that bisphosphonates may have direct anti-tumour effects. CONCLUSIONS Zoledronic acid is the only bisphosphonate that has demonstrated statistically significant, long-term clinical benefits through the prevention and delay of skeletal-related events in patients with metastatic prostate cancer or renal cell carcinoma.
Collapse
Affiliation(s)
- Fred Saad
- Centre Hospitalier de I'Université de Montréal, Hôpital Notre-Dame, 1560 Rue Sherbrooke East, Montréal, Quebec, Canada PQ H2L 4M1.
| |
Collapse
|
44
|
Body JJ. Bisphosphonates in Advanced Malignant Disease. Clin Rev Bone Miner Metab 2007. [DOI: 10.1007/s12018-007-9003-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
45
|
Abstract
Approximately two-thirds of patients with bone metastases have severe and debilitating pain. Despite a range of treatments, about 25% of patients with painful bone metastases suffer from uncontrolled pain. Bisphosphonates are the standard care for the reduction of skeletal events associated with bone metastases. We review the efficacy of currently available bisphosphonates in cancer-related bone pain. Oral clodronate, intravenous (i.v.) pamidronate, and i.v. zoledronic acid have shown an analgesic effect in some studies. Both i.v. and oral ibandronate reduced bone pain in breast cancer patients with bone metastases and maintained bone pain scores below baseline levels for up to two years in clinical trials. Pilot studies of intensive i.v. ibandronate dosing show rapid and effective relief from moderate-to-severe bone pain in patients with breast cancer and other tumors. Phase III trials are warranted to compare the efficacy of bisphosphonates in treating bone pain and to confirm the effects of intensive dosing regimens.
Collapse
Affiliation(s)
- Julie Gralow
- University of Washington School of Medicine, Seattle, Washington 98109, USA.
| | | |
Collapse
|
46
|
Diel IJ. Effectiveness of bisphosphonates on bone pain and quality of life in breast cancer patients with metastatic bone disease: a review. Support Care Cancer 2007; 15:1243. [PMID: 17393190 DOI: 10.1007/s00520-007-0244-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2007] [Accepted: 03/01/2007] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Almost all patients with breast cancer and bone metastases suffer bone pain. Many receive bisphosphonate therapy only when the pain becomes unbearable or there is a direct threat of skeletal complications. DISCUSSION However, clinical trial data demonstrate that bisphosphonates offer significant and sustained relief from bone pain and can also improve quality of life in patients with metastatic breast cancer. CONCLUSION Moreover, new treatment schedules using high dose bisphosphonates can offer rapid relief of acute, severe bone pain.
Collapse
Affiliation(s)
- Ingo J Diel
- Institute for Gynecological Oncology, Mannheim, Germany.
- CGG-Klinik GmbH, Quadrat P7 16-18, 68161, Mannheim, Germany.
| |
Collapse
|
47
|
Abstract
As life expectancy increases throughout the 21st century, the size of the elderly population will also expand. This will have a marked effect on the number of patients with cancer who are classified as elderly. Despite this, the design of most clinical studies of cancer therapies excludes those patients who are > or =70 years of age. Bisphosphonates are an example of a cancer therapy that has not been examined in randomized clinical trials of elderly patients. These agents are used for the prevention of skeletal complications and the relief of bone pain in patients with bone metastases. When deciding which bisphosphonate to prescribe to an elderly patient, each drug should be considered on its individual merits. Examples of areas of concern with bisphosphonates in elderly patients include their relative renal safety profiles and propensity for osteonecrosis of the jaw. Another consideration when choosing the most appropriate formulation is the preferred method of administration (oral or i.v.), which may affect patient compliance with therapy. As the use of bisphosphonates increases, the need for data on their use in elderly patients also becomes greater. Clinical trials of bisphosphonates in this patient population are currently under way, and their results are keenly awaited.
Collapse
Affiliation(s)
- Cesare Gridelli
- Division of Medical Oncology, SG Moscati Hospital, Contrada Amoretta, 83100 Avellino, Italy.
| |
Collapse
|
48
|
Ripamonti C, Fagnoni E, Campa T, Giardina V, Brunelli C, Pigni A, De Conno F. Decreases in pain at rest and movement-related pain during zoledronic acid treatment in patients with bone metastases due to breast or prostate cancer: a pilot study. Support Care Cancer 2007; 15:1177-84. [PMID: 17333295 DOI: 10.1007/s00520-007-0230-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2006] [Accepted: 01/30/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND In patients with bone metastases, pain may be absent or moderate at rest, but may be exacerbated by different movements or positions. No study has evaluated separately pain at rest and on movement in patients with bone metastases undergoing treatment with zoledronic acid (ZA). AIM The aim of this prospective observational study was to evaluate the reduction in intensity of pain at rest and in movement-related pain after treatment with up to six infusions of ZA 4 mg every 28 days in patients with painful bone metastases due to breast or prostate cancer cared for at the Oncological Units and Pain Therapy and Palliative Care Unit of the NCI of Milano. MATERIALS AND METHODS Pain was assessed by a six-level verbal rating scale (0-5 score) at baseline and on each infusion as well as at follow-up visits (2 weeks after every infusion). The two main endpoints (estimated reduction in pain and movement-related pain) were defined as the difference between the baseline score and the average of all the post-treatment scores for each patient. To allow for the potential confounding effect of analgesic consumption, patients without any increase in analgesic consumption during zoledronic acid treatment were also analyzed as a separate subgroup. RESULTS Forty-eight patients with breast (34) or prostate cancer (14) were enrolled. At baseline, 100% of the patients had pain on movement, in 65% of them, the intensity ranged from moderate to very severe, in 61% of the patients, the intensity of pain on movement was higher than the intensity of pain at rest (average difference 0.89; 95% CI, 0.5-1.30). The estimated mean intensity reduction of pain at rest and on movement was: (a) 0.62 (95% CI, 0.28-0.98) and 0.79 (95% CI, 0.43-1.14), respectively, during the first 90 days of ZA treatment; (b) 0.59 (95% CI, 0.23-0.96) and 0.86 (95% CI, 0.49-1.23), respectively, during the entire treatment and follow-up period. Analgesic consumption decreased or was stable on average in 31 and 27%, respectively, of available follow-up data. In the 14 patients with decreased or stable analgesic consumption, pain reduction was 0.61 and 1.01, respectively. CONCLUSIONS In this study, at baseline, all the patients with painful bone metastases experience movement-related pain, and during zoledronic acid treatment, a decrease for both pain at rest and on movement was obtained.
Collapse
Affiliation(s)
- Carla Ripamonti
- Day Hospital and Out-Patient Clinic, Rehabilitation and Palliative Care Operative Unit, National Cancer Institute of Milano, Milan, Italy.
| | | | | | | | | | | | | |
Collapse
|
49
|
Bobba RS, Beattie K, Parkinson B, Kumbhare D, Adachi JD. Tolerability of different dosing regimens of bisphosphonates for the treatment of osteoporosis and malignant bone disease. Drug Saf 2007; 29:1133-52. [PMID: 17147460 DOI: 10.2165/00002018-200629120-00005] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Bisphosphonates are the primary pharmacological agents used for the management of osteoporosis and hypercalcaemia of malignant bone disease. The efficacy of these agents in these two conditions has been demonstrated in many well designed trials published over the past 2 decades. The variety of bisphosphonates currently available to us provides a wide range of tolerability and dosing profiles thus necessitating a thorough comparison of the most recent oral and intravenous bisphosphonates to differentiate the clinical context in which they should be used. Despite the fact that bisphosphonates are generally well accepted, their tolerability is dependent on complications which encompass gastrointestinal (GI) and renal toxicity. Other adverse events include osteonecrosis of the jaw, arthralgias, flu-like symptoms and uveitis. Studies have shown that various dosing regimens are able to modulate these rates of toxicity. To maximise tolerability, the direction of future therapy will likely fall into a pattern of decreasing the frequency of administration of bisphosphonates, whether it is oral or intravenous formulations, thus improving patient adherence. To review the literature on different dosing regimens of various bisphosphonates and their associated tolerability, we searched MEDLINE for articles from 1975 to 2006. Oral bisphosphonates, in particular alendronate and risedronate, have been systematically evaluated with regards to GI toxicity. Overall tolerability with these oral formulations has found GI toxicity to be the primary adverse event of interest. Both alendronate and risedronate have been found to have similar rates of GI toxicity when compared with placebo. Mounting evidence has developed validating the use of intravenous ibandronate and zoledronic acid for the purpose of treating hypercalcaemia secondary to malignancy. Unique to all other bisphosphonates, ibandronate also has an oral form which has a similar GI-toxicity profile to placebo. In addition, no significant differences in renal toxicity have been observed between those receiving intravenous ibandronate compared with placebo. Because of its potency and mode of administration, zoledronic acid has been widely accepted for the treatment of hypercalcaemia secondary to malignancy. However, a decrease in renal function, albeit rare, remains a significant complication of zoledronic acid; therefore, regular renal monitoring is recommended.
Collapse
Affiliation(s)
- Raja S Bobba
- Division of Rheumatology, McMaster University, Hamilton, Ontario, Canada
| | | | | | | | | |
Collapse
|
50
|
Vassiliou V, Kalogeropoulou C, Christopoulos C, Solomou E, Leotsinides M, Kardamakis D. Combination ibandronate and radiotherapy for the treatment of bone metastases: Clinical evaluation and radiologic assessment. Int J Radiat Oncol Biol Phys 2007; 67:264-72. [PMID: 17084550 DOI: 10.1016/j.ijrobp.2006.08.022] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2006] [Revised: 08/01/2006] [Accepted: 08/03/2006] [Indexed: 11/17/2022]
Abstract
PURPOSE Ibandronate is a single-nitrogen, noncyclic bisphosphonate with proven efficacy for reducing metastatic bone pain. In this study, we assessed the palliative effects of combined ibandronate and radiotherapy. METHODS AND MATERIALS Forty-five patients with bone metastases from various solid tumors received external-beam radiotherapy, 30-40 Gy over 3-4.5, weeks combined with 10 cycles of monthly intravenous ibandronate, 6 mg. RESULTS After combined therapy, mean bone pain scores (graded from 0 to 10) were reduced from 6.3 at baseline to 0.8 after 3 months, with further reductions at later time points (all p < 0.001). Opioid use decreased from 84% of patients at baseline (38/45) to 24% (11/45) at 3 months, with further subsequent reductions (all p < 0.001). Mean performance status and functioning scores also significantly improved. Bone density (assessed by computed tomography scan) increased by 20% vs. baseline at 3 months, 46% at 6 months, and 73% at 10 months (all p < 0.001). Lesion improvement was also demonstrated by magnetic resonance imaging. Treatment was well tolerated with no renal toxicity. CONCLUSIONS In this pilot study, combined radiotherapy and ibandronate provided substantial bone pain relief and increased bone density. Computed tomography-based or magnetic resonance imaging-based evaluations offer objective methods for assessing therapeutic outcomes.
Collapse
Affiliation(s)
- Vassilios Vassiliou
- Department of Radiotherapy, University of Patras Medical School, Patras, Greece
| | | | | | | | | | | |
Collapse
|