There are various therapies to help treat bone metastases that may occur as a result of advanced cancers of solid tumors. IV bisphosphonates have been shown to be efficacious in treating bone metastases while also helping to reduce other co-morbidities associated with advanced solid tumors.
Intravenous bisphosphonates are efficacious in treating bone metastases because they have a high affinity for and bind readily to bone matrix.[1] They inhibit osteo-clast mediated bone resportion, which causes the bone remodeling cycle to slow, and bone mineral density to increase.[3]
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Zoledronic acid |
Pamidronate disodium |
FDA indications |
Treatment of:
- Moderate or severe hypercalcemia of malignancy[5]
- Bone metastases from solid tumors[*5]
- Multiple myeloma[4]
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Treatment of:
- Moderate or severe hypercalcemia of malignancy[4]
- Osteolytic bone metastases of breast cancer and osteolytic lesions of multiple myeloma[4]
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Dosing and infusion time/schedule |
- Hypercalcemia of malignancy: 4 mg IV over no less than 15 minutes, single dose, but may consider retreatement after a minimum of 7 days[5]
- Multiple myeloma and bone metastases:4 mg IV over no leass than 15 minutes every 3—4 weeks[5]
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- Hypercalcemia of malignancy: 60--90 mg IV over 2—24 hours, single dose, but may consider retreatement after a minimum of 7 days[4]
- Osteolytic bone metastases of breast cancer: 90 mg IV over 2 hours, every 3—4 weeks[4]
- Multiple myeloma: 90 mg IV over a 4 hour period on a monthly basis
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Types of bone lesions on which agents act |
- Osteolytic[6]
- Osteoblastic[6]
- Mixed[6]
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*Prostate cancer should have progressed after treatment with at least 1 hormonal therapy.
1. Reich CD Advances in the treatment of bone metastases.
Clin J Oncol Nurs. 2003; 7:641-6.
2. Viale PH, Sanchez Yamamoto D. Bisphosphonates: expanded roles in the treatment of patients with cancer. Clin J Oncol Nurs. 2003; 7:393-401.
3. Blum RH, Novetsky D, Shasha D, Fleishman S. The multidisciplinary approach to bone metastases. Oncology. 2003;17:845-57.
4. Aredia [package insert]. East Hanover, NJ: Novartis Pharmaceuticals Corp; 2004.
5. ZOMETA [package insert]. Stein, Switzerland: Novartis Pharmaceuticals Corp; 2004.
6. Rosen L, Harland SJ, Oosterlinck W. Broad clinical activity of zoledronic acid in osteolytic to osteoblastic bone lesions in patients with a broad range of solid tumors. Am J Clin Oncol. 2002;25(6 suppl 1):S19-S24.
