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Guidance on the use of bisphosphonates in solid tumours: recommendations of an international expert panel

Aapro, M; Abrahamsson, Per-Anders LU ; Body, J. J.; Coleman, R. E.; Colomer, R.; Costa, L.; Crinò, L.; Dirix, L.; Gnant, M. and Gralow, J., et al. (2008) In Annals of Oncology 19(3). p.420-432
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... (More)
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. (Less)
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Contribution to journal
publication status
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in
Annals of Oncology
volume
19
issue
3
pages
420 - 432
publisher
Oxford University Press
external identifiers
  • pmid:17906299
  • wos:000253746200004
  • scopus:40149083563
ISSN
1569-8041
DOI
10.1093/annonc/mdm442
language
English
LU publication?
yes
id
7c91f73c-1965-407f-8323-ef36547343b5 (old id 1138024)
date added to LUP
2008-04-25 15:31:42
date last changed
2017-09-17 06:52:04
@article{7c91f73c-1965-407f-8323-ef36547343b5,
  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.},
  author       = {Aapro, M and Abrahamsson, Per-Anders and Body, J. J. and Coleman, R. E. and Colomer, R. and Costa, L. and Crinò, L. and Dirix, L. and Gnant, M. and Gralow, J. and Hadji, P. and Hortobagyi, G. N. and Jonat, W. and Lipton, A. and Monnier, A. and Paterson, A. H. G. and Rizzoli, R. and Saad, F. and Thürlimann, B.},
  issn         = {1569-8041},
  language     = {eng},
  number       = {3},
  pages        = {420--432},
  publisher    = {Oxford University Press},
  series       = {Annals of Oncology},
  title        = {Guidance on the use of bisphosphonates in solid tumours: recommendations of an international expert panel},
  url          = {http://dx.doi.org/10.1093/annonc/mdm442},
  volume       = {19},
  year         = {2008},
}