Kamal S Saini, MD, MRCP (UK), DM
Kamal S Saini, MD, MRCP (UK), DM
Male, 36
Bangalore - India
Specialties: Medical Oncology
Interests: Cancer, Lung Cancer, Chemotherapy
Male, 36
Bangalore - India
Specialties: Medical Oncology
Interests: Cancer, Lung Cancer, Chemotherapy
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Bisphosphonates in Breast Cancer
Mar 29, 2009 11:36AM
- 5 comments
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Zoledronic acid has found acceptance among the oncology community for a number of applications. These include tumor induced hypercalcemia, for reducing bone pain from skeletal metastases, reducing skeletal-related events, osteoporosis, and for possibly delaying (or even preventing) skeletal metastases.
Janet E Brown and Robert E Coleman . The role of bisphosphonates in breast cancer: The present and future role of bisphosphonates in the management of patients with breast cancer. Breast Cancer Res 2002, 4:24-29
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Cochrane Review
Background
Bone is the most common site of metastatic disease associated with breast cancer (BC). Bisphosphonates inhibit osteoclast-mediated bone resorption.
Objectives
To assess the effect of Bisphosphonates on skeletal events (SEs), bone pain, quality of life (QOL) and survival in women with early (E) and advanced breast cancer (ABC).
Results
Bisphosphonates reduce the incidence of skeletal events. Women with ABC and clinically evident bone metastases treated with Bs showed significant delays in the median time to SE. Treatment with Bisphosphonates does not appear to affect survival in women with ABC. Bisphosphonates in women with ABC without clinically evident bone metastases do not reduce SE incidence.
Authors' conclusions
In women with ABC and clinically evident bone metastases, Bisphosphonates (PO,IV)) reduce the risk of developing SEs and SE rate, as well as delaying the time to SE. Some Bisphosphonates may also reduce bone pain and may improve QOL.
Pavlakis N, Schmidt RL, Stockler MR. Bisphosphonates for breast cancer. Cochrane Database of Systematic Reviews 2005, Issue 3. Art. No.: CD003474.
_____________________________________________________________________________________
Janet E Brown and Robert E Coleman . The role of bisphosphonates in breast cancer: The present and future role of bisphosphonates in the management of patients with breast cancer. Breast Cancer Res 2002, 4:24-29
__________________________________________________________________________________________
Cochrane Review
Background
Bone is the most common site of metastatic disease associated with breast cancer (BC). Bisphosphonates inhibit osteoclast-mediated bone resorption.
Objectives
To assess the effect of Bisphosphonates on skeletal events (SEs), bone pain, quality of life (QOL) and survival in women with early (E) and advanced breast cancer (ABC).
Results
Bisphosphonates reduce the incidence of skeletal events. Women with ABC and clinically evident bone metastases treated with Bs showed significant delays in the median time to SE. Treatment with Bisphosphonates does not appear to affect survival in women with ABC. Bisphosphonates in women with ABC without clinically evident bone metastases do not reduce SE incidence.
Authors' conclusions
In women with ABC and clinically evident bone metastases, Bisphosphonates (PO,IV)) reduce the risk of developing SEs and SE rate, as well as delaying the time to SE. Some Bisphosphonates may also reduce bone pain and may improve QOL.
Pavlakis N, Schmidt RL, Stockler MR. Bisphosphonates for breast cancer. Cochrane Database of Systematic Reviews 2005, Issue 3. Art. No.: CD003474.
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Dr. Saini,
May I ask you a general question about the side effects of intravenous bisphosphonate injection?
Specifically, in regards to Central Nervous side effects such as the reported anxiety, irritability, depressed mood, etc.
Are these effects transient (they are no longer present) after about 7 days time, or can these effects be with someone for the duration of the half-life of the drug (many years)?
Thanks.
May I ask you a general question about the side effects of intravenous bisphosphonate injection?
Specifically, in regards to Central Nervous side effects such as the reported anxiety, irritability, depressed mood, etc.
Are these effects transient (they are no longer present) after about 7 days time, or can these effects be with someone for the duration of the half-life of the drug (many years)?
Thanks.
Dr. Saini -
Could you please elaborate more about the result of Bs on the (E) stage of this disease? Where there conclusions drawn regarding the prevention or delay of (SE) or survival rates?
Thank you for your response.
Could you please elaborate more about the result of Bs on the (E) stage of this disease? Where there conclusions drawn regarding the prevention or delay of (SE) or survival rates?
Thank you for your response.
Bump!
Hi All,
Thanks for the questions/comments, and sorry for the delay in posting my response.
Rob, the side effects theoretically include some CNS effects especially headaches. Other effects mentioned by you are very uncommon. Adverse effects are generally transient.
VaBreeze, the question of using bisphosphonates in early breast cancer in the adjuvant setting is currently a matter of intense research. NSABP B-34, AZURE, and the SWOG 0307 are clinical trials specifically investigating the ability (if any) of bisphosphonates to decease the risk of distant metastases in women with breast cancer with no known metastases. Mature data is as yet unavailable, and is eagerly awaited. Many oncologists do use bisphosphonates in women with early breast cancer (especially if they are on anastrazole or letrozole, or if they have low bone density).
Additional info on bisphosphonates:
Bisphosphonates are bone-tageting drugs, synthetic analogues of inorganic pyrophosphate.
Used in osteoporosis, hypercalcemia, Pagets disease of bone, multiple myeloma, bony metastases from various solid malignancies.
There are two broad groups: non-nitrogen containing bisphosphonates (clodronate, etidronate) and the nitrogen containing (alendronate, ibandronate, pamidronate, risedronate, zoledronate).
Bisphosphonates alter the function of bone cells called osteoclasts to make the bone microenvironment less fertile soil for tumor to seed and grow in, thus preventing or at least decreasing bony metastases. In clinical trials, this family of drugs has significantly decreased the occurrence of skeletal related events.
(Ref: R Layman et al, Bisphosphonates for breast cancer. Hematology Oncology Clinics of North America. April 2007)
Thanks for the questions/comments, and sorry for the delay in posting my response.
Rob, the side effects theoretically include some CNS effects especially headaches. Other effects mentioned by you are very uncommon. Adverse effects are generally transient.
VaBreeze, the question of using bisphosphonates in early breast cancer in the adjuvant setting is currently a matter of intense research. NSABP B-34, AZURE, and the SWOG 0307 are clinical trials specifically investigating the ability (if any) of bisphosphonates to decease the risk of distant metastases in women with breast cancer with no known metastases. Mature data is as yet unavailable, and is eagerly awaited. Many oncologists do use bisphosphonates in women with early breast cancer (especially if they are on anastrazole or letrozole, or if they have low bone density).
Additional info on bisphosphonates:
Bisphosphonates are bone-tageting drugs, synthetic analogues of inorganic pyrophosphate.
Used in osteoporosis, hypercalcemia, Pagets disease of bone, multiple myeloma, bony metastases from various solid malignancies.
There are two broad groups: non-nitrogen containing bisphosphonates (clodronate, etidronate) and the nitrogen containing (alendronate, ibandronate, pamidronate, risedronate, zoledronate).
Bisphosphonates alter the function of bone cells called osteoclasts to make the bone microenvironment less fertile soil for tumor to seed and grow in, thus preventing or at least decreasing bony metastases. In clinical trials, this family of drugs has significantly decreased the occurrence of skeletal related events.
(Ref: R Layman et al, Bisphosphonates for breast cancer. Hematology Oncology Clinics of North America. April 2007)
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