Smith Matthew R
Massachusetts General Hospital Cancer Center, Division of Hematology and Oncology, Boston, 02114, USA.
Cancer Treat Rev. 2005;31 Suppl 3:19-25. doi: 10.1016/j.ctrv.2005.09.004. Epub 2005 Oct 14.
Bone metastases are a major cause of cancer morbidity. Bone metastases are associated with pain, fractures, spinal cord compression, ineffective haematopoiesis, and hypocalcaemia of malignancy. The goals of treatment for bone metastases are to prevent disease-related skeletal complications, palliate pain, and maintain quality of life. Bisphosphonates are a standard part of supportive care for patients with bone metastases. Zoledronic acid, a nitrogen containing third generation bisphosphonate, is the most active and is the most thoroughly investigated bisphosphonate for metastatic bone disease. The efficacy and safety of zoledronic acid has been established in three pivotal prospective, randomized controlled trials involving more than 3000 subjects. The evidence is reviewed here with a focus on clinical relevance. Across a broad array of tumour types, zoledronic acid (4 mg intravenously over 15 min every 3-4 weeks) decreased the frequency of skeletal-related events, delayed the time to a first skeletal-related event, and reduced pain. Zoledronic acid is more effective than pamidronate in breast cancer and the only bisphosphonate proven effective for metastatic prostate cancer, lung cancer, renal cell carcinoma and other solid tumours.
骨转移是癌症发病的主要原因。骨转移与疼痛、骨折、脊髓压迫、造血功能无效以及恶性肿瘤导致的低钙血症相关。骨转移的治疗目标是预防与疾病相关的骨骼并发症、缓解疼痛并维持生活质量。双膦酸盐是骨转移患者支持性治疗的标准组成部分。唑来膦酸是含氮的第三代双膦酸盐，是治疗转移性骨病最具活性且研究最为充分的双膦酸盐。唑来膦酸的疗效和安全性已在三项涉及3000多名受试者的关键前瞻性随机对照试验中得到证实。在此对相关证据进行综述，重点关注其临床相关性。在多种肿瘤类型中，唑来膦酸（每3 - 4周静脉注射4毫克，持续15分钟）降低了骨相关事件的发生率，延迟了首次骨相关事件的发生时间，并减轻了疼痛。在乳腺癌中，唑来膦酸比帕米膦酸更有效，并且是唯一被证实对转移性前列腺癌、肺癌、肾细胞癌和其他实体瘤有效的双膦酸盐。
