Horváth Zsolt
Országos Onkológiai Intézet, Kemoterápia B Belosztály, Budapest, Hungary.
Magy Onkol. 2002;46(4):361-4. Epub 2003 Feb 1.
Bisphosphonates are effective against increased bone resorption because they inhibit osteoclast activity. The use of these drugs is well established for the treatment of metastatic breast and other cancers; they reduce skeletal complications, hypercalcemia, bone pain, and metastatic progression and they can improve the overall survival and quality of life. Preclinical observations and early clinical data indicate that early bisphosphonate treatment reduces the incidence and the extent of newly developed metastases in breast cancer. There is considerable interest in determining whether bisphosphonate treatment is to prevent the incidence of bone metastases and associated complications. To date three randomized, controlled clinical trials have examined the effect of long-term use of clodronate (1600 mg/d po.) on the incidence of bone metastases, other metastases, the survival of patients, and the side effects of the study drug as well. All the trials have observed significant reduction of the occurrence of bone metastases, although this reduction was significant only during the medication period. One of the trials mentioned have shown an unexpected reduction in non-osseous metastases, and two of them have revealed significant improvements in the death rates. These promising results need further evaluation by large clinical trials with longer treatment periods to establish the clinical role of adjuvant bisphosphonate treatment of primary breast cancer.
双膦酸盐类药物可有效对抗骨吸收增加，因为它们能抑制破骨细胞活性。这些药物在治疗转移性乳腺癌及其他癌症方面的应用已得到充分确立；它们可减少骨骼并发症、高钙血症、骨痛和转移进展，还能提高总体生存率和生活质量。临床前观察和早期临床数据表明，早期使用双膦酸盐类药物可降低乳腺癌新发生转移的发生率和程度。人们对确定双膦酸盐类药物治疗是否能预防骨转移及相关并发症的发生率颇感兴趣。迄今为止，已有三项随机对照临床试验研究了长期使用氯膦酸盐（口服1600毫克/天）对骨转移发生率、其他转移、患者生存率以及研究药物副作用的影响。所有试验均观察到骨转移发生率显著降低，尽管仅在用药期间这种降低才具有显著性。上述试验中有一项显示非骨转移意外减少，其中两项显示死亡率有显著改善。这些有前景的结果需要通过更长治疗期的大型临床试验进行进一步评估，以确立辅助性双膦酸盐类药物治疗原发性乳腺癌的临床作用。
