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The Lancet Oncology
Volume 7 • Number 11 • November 2006
Copyright © 2006 Elsevier






Newsdesk
Zoledronic acid palliation in bone-metastatic breast cancer


Bryant Furlow



PII S1470-2045(06)70927-5


Women with painful skeletal-related events (SRE) benefit from second-line zoledronic acid, report researchers (J Clin Oncol, published online Sept 25, 2006; DOI: 10.1200/JCO.2006.05.9212).

Bone is the most common site of metastatic disease in women with breast cancer, frequently causing SRE. A phase II trial of 31 women with SRE and bone disease progression who had received first-line bisphosphonate treatments, showed palliative benefits from zoledronic acid. Women had improved pain control and decreased urinary N-telopeptides, a biomarker of bone turnover, compared with baseline measures.



Appropriate bisphosphonate treatment could save costs

“This study shows that patients with progressive bone metastases or SREs while on clodronate or pamidronate can have palliative benefits with a switch to the more potent bisphosphonate zoledronic acid”, says lead author Mark Clemons (Princess Margaret Hospital, Toronto, Ontario, Canada). “If confirmed in randomised trials, these findings have major implications [for] the use of bisphosphonates.”

“The authors should be commended for giving us information on what to do in a frequent clinical situation”, says Peter Barrett-Lee (Cardiff University, Wales, UK). “Now we have some evidence that switching to a newer, more potent agent might help patients failing on first-line bisphosphonates.”

Many centres already use zoledronic acid as first-line treatment, Barrett-Lee points out. “The new results will not be relevant in such cases”, he notes. “But quite a few [clinicians] still use pamidronate first line.”

“It is too early to draw conclusions about complications, which usually occur later. Physicians should not administer second-line bisphosphonates indefinitely”, comments Meletios Dimopoulos (University of Athens, Greece). Zoledronic acid costs five times more than pamidronate, Clemons notes. “We can use less expensive agents first line and save more costly drugs for patients with progression. Appropriately targeting bisphosphonate therapy to those most likely to benefit could save billions of dollars globally.”