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双膦酸盐类药物在癌症患者中的应用。

The use of bisphosphonates in cancer patients.

作者信息

Wu Shenhong, Dahut William L, Gulley James L

机构信息

Medical Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland 20892, USA.

出版信息

Acta Oncol. 2007;46(5):581-91. doi: 10.1080/02841860701233435.

Abstract

Skeletal-related events resulting from bone metastases or osteoporosis can significantly contribute to morbidity and mortality in cancer patients. Expert opinion on the effectiveness of bisphosphonates in this setting is evolving. Here we review current evidence on the risks and benefits of bisphosphonate therapy for a wide variety of cancers, as well as clinical management of its adverse effects. A MEDLINE search of English-language literature (1966 through May 2006) was conducted using the terms bisphosphonate, cancer, multiple myeloma, malignancy, and randomized controlled clinical studies. Studies were selected based on clinical pertinence, with an emphasis on phase III clinical trials. We reviewed bibliographies for other relevant articles. Accumulating evidence reveals that bisphosphonate therapy has a significant effect in preventing skeletal complications in multiple myeloma, breast cancers, and prostate cancer, and in reducing skeletal complications in other metastatic bone malignancies. Emerging data indicate that bisphosphonates are useful for preventing bone loss resulting from cancer or its therapy. The efficacy of bisphosphonates for early-stage breast cancers remains controversial. Significant risks of bisphosphonate therapy include nephrotoxicity, electrolyte abnormalities, and osteonecrosis of the jaw. Bisphosphonate therapy has a clear role in the management of skeletal metastases associated with a variety of cancers. However, significant side effects require ongoing monitoring and treatment.

摘要

由骨转移或骨质疏松引起的骨相关事件可显著增加癌症患者的发病率和死亡率。关于双膦酸盐在此情况下有效性的专家意见正在不断发展。在此,我们综述了双膦酸盐治疗多种癌症的风险和益处的现有证据,以及其不良反应的临床管理。使用双膦酸盐、癌症、多发性骨髓瘤、恶性肿瘤和随机对照临床研究等术语,对1966年至2006年5月的英文文献进行了MEDLINE检索。根据临床相关性选择研究,重点是III期临床试验。我们查阅了其他相关文章的参考文献。越来越多的证据表明,双膦酸盐治疗在预防多发性骨髓瘤、乳腺癌和前列腺癌的骨骼并发症以及减少其他转移性骨恶性肿瘤的骨骼并发症方面具有显著效果。新出现的数据表明,双膦酸盐可用于预防癌症或其治疗导致的骨质流失。双膦酸盐对早期乳腺癌的疗效仍存在争议。双膦酸盐治疗的重大风险包括肾毒性、电解质异常和颌骨坏死。双膦酸盐治疗在与多种癌症相关的骨转移管理中具有明确作用。然而,严重的副作用需要持续监测和治疗。

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