Kamal S Saini, MD, MRCP (UK), DM  
Male, 48
Bangalore, India

Specialties: Medical Oncology

Interests: Cancer, Lung Cancer, Chemotherapy
Bangalore Institute of Oncology
Medical Oncology
Bangalore, India
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Bisphosphonates in Breast Cancer

Mar 29, 2009 - 16 comments

zoledronic acid




Breast Cancer









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


Cochrane Review

Bone is the most common site of metastatic disease associated with breast cancer (BC). Bisphosphonates inhibit osteoclast-mediated bone resorption.

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).

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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Avatar universal
by Rob2008, Mar 29, 2009
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)?


Avatar universal
by VaBreeze, Mar 30, 2009
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.

Avatar universal
by VaBreeze, Apr 10, 2009

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)

Avatar universal
by Plp714, Nov 28, 2009
My brother was just diagnosed with non-hodgkins lymphoma.  He had a lump removed from his upper left thigh and surgeon said it was an easy task.  Took all surround tissue and cleaned it up, but needed to send for biopsy.  The biopsy came back 10 days later as Panniculitis T-Cell lymphoma.  He went through a battery of tests, which included bone marrow, PET & CAT scans, lots of blood work up and all came back negative.  His spleen showed a slight enlargement.  What they didn't expect was the PET scan results which showed multiple very tiny nodules in both his lungs.Which led to a interventional lung biopsy today, to get a piece of one of the tiny nodules to test it.  Doctor says that if they can't determine what type of cancer, then just go with the agressivie treatment of chemo, which I immediately said "absolutely not". If it isn't definitive why put him through chemo, when we still don't know what the nodules are.   Meanwhile, he has no symptoms.  He does not have a cough.  He is not short of breath.  He exercises and walks every day with no problem.  If it wasn't for the lump that he had in his leg, (which was removed) we would not know any of this.  My question to anyone that can help is:  Has anyone heard of this with lymphoma?  Could the nodules be just scar tissue from  previous pneumonias he has has over the years?  Do we wait and see if the nodules are less in numbers in three months?  I'm at a loss.  If anyone can give me some advice I would appreciate it.....Pat

1173998 tn?1263541640
by yaxine, Jan 15, 2010
hi, my symtoms is had a head ache, then my saliva have a black color, ithink it is a blood and not good odor, sometimes i suffer a pain of my nose,ihave a sore throat, and ihave a symptoms that my gums are bleeding,,,,,, i feel the odor of my mouth is like a coffe,,,,,, im not a smokers and drinkers of any hard,,,,,, my question is,,,,, do u think it is a oral cancer?

Avatar universal
by mdad85, Mar 22, 2010
I was diagnosed with Uterine cancer in November 2009, In the middle of Nov. I had complete hysterectomy, Dr stated can was stage 4 B, he wanted to do Chemo. I elected to not have the Chemo because I have had 3 family members die shortly after Chemo. My question is Now I am Having pains in my right side,stomach is swelling, but it may be becasue I'm putting on weight, clothes getting tighter, Headaches, Upset stomach. Dr told me after surgery that the cancer was on all my organs and he had trouble removing it.
I guess what I'm asking is these new problems , are they most likely cancer, and if I do not take treatments what is your best guess of my remaining time, I know there is no way to know for sure, Just your best guess.
I'm  just turned 60 yrs old and am Diabetic, I lost my left leg from the knee done in Sept.
Than You for your time.

Avatar universal
by tish1964, Apr 14, 2010
My dad had colon cancer about 2 years ago, ten months ago he had 2 units of blood for low blood volume. I have lived and cared for him for 8 months and last week he became pale, weak, and lost his appetite.within a day and a half he became grayish yellow and was taken to the ER. he was severely anemic.After 4 pints of Blood and many test they said that his platlets were low and his spleen was enlarged. They also found a mass in his abdomen but did nothing about that yet. he underwent many tests, ct scan, upper gi, and colonoscopy , they removed polups  from his esophagus and sent them for biopsy.no bleed was found. after 5 days at the hospital his Doc told me sometimes enough was enough. He has refered my dad to an Oncologist, haemotologist and stated that he believed that he had leukemia. My dad is 76 and seems to be still very weak since he returned home. What is the prognosis of someone with advanced age and these symptoms? I dont know what I can expect and would like to know how advanced is it when your spleen is affected, any answers would be helpful?

Avatar universal
by srirag_0194, May 03, 2010
Hello Dr,

My wife have lot of puss in her left side breast and she got huge pain.When i went to doctor he told me to admitted in hospital because she is 8 month in pregnancy. i admitted her immediatly and he(Dr) removed puss from her breast
it any thing related to cancer Or it is dangerous to her future health
iam very much afraid about baby too becoz she is taking more tablet as advice by doctor
please advice me regarding this problem and clarify me what i need to do.

Avatar universal
by sums76, Jul 08, 2010
Dear Dr Saini,

I found your profile on medhelp while I was searching about cyberknife therapy in India.

I am forwarding my mother's case history for your expert advice.

Her doctor at Apollo Hospital Delhi has advised CyberKnife as the treatment suitable for her.
The details are as follows:

My mother was detected CA Breast Lt  in may 2007
25x28mm at 6 position Left Breast,,,Tru cut showed 19/5/07
Infiltrating duct Ca NOS grade 2 with some lobular features
ER + 3/8
PR  negative
HER 2 neu 1(negative)
She was given  adjunctive chemotherapy Anthracycline based sessions
1.Lobodex/Endoxon  with pregalated G-CSF as growth factor supplement..may 2007
2.Lipodex/Endoxon  + pregalated G-CSF as growth factor supplement..    June 2007
3.Lipodex/Endoxon  + pregalated G-CSF as growth factor supplement......July  2007
4.Endoxon/epirubicin+pregalated G-CSF as growth factor supplement......Aug  2007
developed hand and foot syndrome after 4th cycle
5.Decetaxyl + pregalated G-CSF as growth factor supplement
6.Docetaxyl/Tubitiee..........showed 1/3rd reduction in tumour size........   sept 2007
7.Inj Tubitere 135 mg +  pregalated G-CSF as growth factor supplement   Oct 2007
8. Decetaxil 135 mg   + pregalated G-CSF as growth factor supplement   Nov 2007

Then MRM was done  on 16th Jan 2008and Chem was given again Avastin cycles
Histopath reports ;
Grade 2 invasive  with mixed
ER 6/8,PR 4/8 ductal & lobular features vascular emboli seen
HERS 2 Negative   Score 1-)
Nodal Met 7/11 pT2N2aMx
Nottingham Prognostic Index 5.6
She had Supraclav left Nodes detected on Pet Scan and Radiotherapy  given in Oct 2008
pet scan dec 19th 2007 report attached
Avastin cycles given
Then oral hormonal Altraz therapy done
Pet scan Dec 2009 showed  Int mammary LN 1st and 2nd space started Oral chemotherapy Zeloda
CT pet June 2010 shows persistent tiny residual non FDG avid LN are noted in the left Supraclavicular region. Compared to the previous PET CT scan dated Dec 22 2009,there is no significant change noted.
A coalescent FDG avid (SUV max -14,3) soft tissue mass lesion noted in the left parasternal region  measuring 3.7 x 4.4 x 7.8 CM size, the mass is infiltrating 1st and 2nd Intercostal spaces.Compared to the previous PET CT Scan dated Dec 22 the mass lesion shows increase in size and FDG uptake
At present she is taking 1000mg of Capita twice daily.

Could you please advise us and please send me the details about the cost of the Cyberknife treatment, the duration, side effects, etc.

Thanking You.


S Raza

Avatar universal
by moina, Aug 26, 2010
Dear Dr
My friend who is a male of 24 yrs was diagnosed of DSRCT last year(march 2009) and underwnt surgery where it was removed and was follwed with chemo and radiation trtmnts..which is still goin on(from regional cancer center in kerala , india)... and subsequent scans came clear by God's grace.
recently he witnessed blood in his urine due to doc recommndd for another scan.. and following is the report.


The doc said nothing to worry..and she wants to observe its metabolic activity for anothr 3 months and thn tak another scan and meanwhile she will continue with chemo..we all are really worried..kindly giv some advice

Avatar universal
by stacy_frasier24, Sep 09, 2010
have a gentalman living in our household has severe vomiting that comes and goes frequently,and will vomit for days on end,normally it ends up being by the buckets full.he has hep b and is a recovering alcoholic,he has elevated bilirubone,chrimson colored urine,low potassium associated with pancretitis,a low grade fever,and severe adominal pain with the vomiting.....they have done full body xrays,full blood culture,and had a normal urinalasis,liver function is high.....what are the possibilities of pancreatic cancer?still waiting for results...

Avatar universal
by julieben, Jul 16, 2011
Dr.  Kamal S Saini, i wrote you in 2009 and have not been able to get in touch with you anymore.  Are you still on this site.???  Would love to hear from you.  You gave me such good information. Julie

Avatar universal
by samiralove1, Nov 12, 2012


How are you today?

It is my great pleasure to contact you.

I know that you will grant my request in good faith and understanding, my name is Samira.

I wish you will have the desire to write me back through my email for easiest communication.

Please I'm   much hoped that you will answer my mail it is very important for me.

We shall understand more better after our correspondence including my picture and details about my self.you can write me at(***@****)

Best Regards.Miss,Samira.

Avatar universal
by samiralove1, Nov 12, 2012


How are you today?

It is my great pleasure to contact you.

I know that you will grant my request in good faith and understanding, my name is Samira.

I wish you will have the desire to write me back through my email for easiest communication.

Please I'm   much hoped that you will answer my mail it is very important for me.

We shall understand more better after our correspondence including my picture and details about my self.you can write me at(samirajamal2x2 @gmx.co m)

Best Regards.Miss,Samira.

Avatar universal
by Tufic, Apr 06, 2014

Hope this note finds you well,

Please Can you help me to figure out the following problem that I experiencing :

I'm 34 y old, Male , Married , Good general Health ,

Since couple years I got external Hemorrhoid ( only one piece ) , It some times swallow and get hurt but heal few days later , the PROBLEM I suffer now is ..... Some times when I get sexual stimulation I start to feeling mild pain in my Hemorrhoid !!! it this something normal?

Thank you so much for your kind replay.


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