Body Jean-Jacques
Department of Internal Medicine, Institut Jules Bordet, Université Libre de Bruxelles, Belgium.
Support Care Cancer. 2006 May;14(5):408-18. doi: 10.1007/s00520-005-0913-5. Epub 2006 Feb 1.
This review relates to the efficacy and safety of bisphosphonates in metastatic bone disease. It discusses practical recommendations and possible future indications for bisphosphonate therapy. The current aims of bisphosphonates for metastatic bone disease are to prevent skeletal-related events (SREs), reduce bone pain and improve quality of life. Phase III clinical trials of clodronate and pamidronate have established their efficacy against bone complications in patients with breast cancer and multiple myeloma, while randomized trials have shown SRE reductions with zoledronic acid in patients with breast cancer and multiple myeloma, prostate cancer, and lung and other solid tumors. These bisphosphonates also have some effect on metastatic bone pain. Ibandronate is a new aminobisphosphonate, available in more than 40 countries outside of the US as intravenous and oral formulations for the prevention of skeletal events in patients with breast cancer and bone metastases. Phase III studies have shown that both intravenously and orally administered ibandronate have efficacy for the prevention of skeletal events and for the reduction of metastatic bone pain. In addition to efficacy, the long-term tolerability of bisphosphonates in metastatic bone disease influences drug selection. Besides their use in patients with established bone metastases, recent and ongoing research suggests that bisphosphonates also have clinical benefit in the adjuvant setting, and for the treatment of cancer-treatment-induced bone loss. Such interesting new developments may underpin a new era of bisphosphonate use sometime in the near future.
本综述涉及双膦酸盐在转移性骨病中的疗效和安全性。它讨论了双膦酸盐治疗的实用建议和未来可能的适应证。双膦酸盐用于转移性骨病的当前目标是预防骨相关事件（SREs）、减轻骨痛并改善生活质量。氯膦酸盐和帕米膦酸盐的III期临床试验已证实其对乳腺癌和多发性骨髓瘤患者的骨并发症有效，而随机试验表明，唑来膦酸可降低乳腺癌和多发性骨髓瘤、前列腺癌以及肺癌和其他实体瘤患者的SREs。这些双膦酸盐对转移性骨痛也有一定作用。伊班膦酸钠是一种新型氨基双膦酸盐，在美国以外的40多个国家作为静脉和口服制剂上市，用于预防乳腺癌和骨转移患者的骨事件。III期研究表明，静脉注射和口服伊班膦酸钠对预防骨事件和减轻转移性骨痛均有效。除疗效外，双膦酸盐在转移性骨病中的长期耐受性也会影响药物选择。除了用于已发生骨转移的患者外，近期和正在进行的研究表明，双膦酸盐在辅助治疗以及治疗癌症治疗引起的骨质流失方面也具有临床益处。这些有趣的新进展可能在不久的将来开启双膦酸盐使用的新时代。
