Major Pierre
Department of Medicine, McMaster University, 699 Concession Street, Hamilton, Ontario, Canada L8V 5C2.
Oncologist. 2002;7(6):481-91. doi: 10.1634/theoncologist.7-6-481.
Hypercalcemia of malignancy is a serious complication of cancer that affects patients with and without bone metastases. A single infusion of pamidronate disodium, a nitrogen-containing bisphosphonate, effectively normalizes serum calcium in the majority of patients treated for up to 1 month. Zoledronic acid is a new-generation, heterocyclic nitrogen-containing bisphosphonate and the most potent inhibitor of bone resorption identified to date.
The natural history, clinical presentation, and treatment of hypercalcemia of malignancy are reviewed, with a focus on the mechanisms of action and relative efficacy and safety of bisphosphonate therapies.
The improved efficacy of zoledronic acid compared with pamidronate disodium has been demonstrated in a pooled analysis of two randomized clinical trials in patients with hypercalcemia of malignancy. In these trials, both zoledronic acid and pamidronate disodium were safe and well tolerated; however, zoledronic acid treatment resulted in a significantly higher number of complete responses, more rapid calcium normalization, and more durable responses compared with pamidronate disodium.
Given the superior efficacy and comparable safety profile of zoledronic acid compared with pamidronate disodium, zoledronic acid is likely to become the treatment of choice for hypercalcemia of malignancy.
恶性肿瘤高钙血症是癌症的一种严重并发症，影响有或无骨转移的患者。单次输注帕米膦酸二钠（一种含氮双膦酸盐）可使大多数接受治疗长达1个月的患者血清钙恢复正常。唑来膦酸是新一代含氮杂环双膦酸盐，是迄今为止已确定的最有效的骨吸收抑制剂。
对恶性肿瘤高钙血症的自然病史、临床表现及治疗进行综述，重点关注双膦酸盐治疗的作用机制、相对疗效及安全性。
在两项针对恶性肿瘤高钙血症患者的随机临床试验的汇总分析中，已证明唑来膦酸与帕米膦酸二钠相比疗效更佳。在这些试验中，唑来膦酸和帕米膦酸二钠均安全且耐受性良好；然而，与帕米膦酸二钠相比，唑来膦酸治疗导致完全缓解的患者数量显著更多、血钙恢复正常更快且缓解更持久。
鉴于唑来膦酸与帕米膦酸二钠相比疗效更优且安全性相当，唑来膦酸可能会成为恶性肿瘤高钙血症的首选治疗药物。
