Diel Ingo J, Bergner Raoul, Grötz Knut A
Institute for Gynecological Oncology, Mannheim, Germany.
J Support Oncol. 2007 Nov-Dec;5(10):475-82.
Four bisphosphonates are used for the treatment of metastatic bone disease: clodronate, which is available outside the United States in both intravenous and oral formulations; intravenous pamidronate; intravenous zoledronic acid; and ibandronate, which is also available in intravenous and oral forms. Since the use of bisphosphonates in patients with cancer is palliative, their impact on patients' quality of life and their adverse-effect profiles are essential considerations for effective patient management. The most common adverse effects associated with bisphosphonates are renal toxicity, acute-phase reactions, gastrointestinal (GI) toxicity, and osteonecrosis of the jaw (ONJ). The incidence of these adverse events varies significantly between bisphosphonates. Renal toxicity is a potentially life-threatening event reported in studies of zoledronic acid and, to a lesser extent, pamidronate. In contrast, the renal safety profile of intravenous ibandronate and oral bisphosphonates is similar to that of placebo. Acute-phase reactions occur only with intravenous aminobisphosphonates and may be more common with zoledronic acid. Gastrointestinal effects occur only with oral agents (clodronate and ibandronate) and may be avoided by adhering to dosing instructions. More recently, ONJ has recently emerged as a complication of bisphosphonate use. However, its true incidence is not yet known. The potential adverse effects of bisphosphonates should be considered in the context of the individual patient's characteristics and preferences when selecting a bisphosphonate for metastatic bone disease.
氯膦酸盐，在美国境外有静脉注射和口服两种剂型；静脉注射帕米膦酸盐；静脉注射唑来膦酸；以及伊班膦酸盐，也有静脉注射和口服两种形式。由于双膦酸盐在癌症患者中的使用是姑息性的，它们对患者生活质量的影响以及不良反应情况是有效管理患者的重要考虑因素。与双膦酸盐相关的最常见不良反应是肾毒性、急性期反应、胃肠道毒性和颌骨坏死（ONJ）。这些不良事件的发生率在不同双膦酸盐之间有显著差异。肾毒性是在唑来膦酸研究中报告的一种潜在危及生命的事件，在帕米膦酸盐研究中程度较轻。相比之下，静脉注射伊班膦酸盐和口服双膦酸盐的肾脏安全性与安慰剂相似。急性期反应仅发生于静脉注射氨基双膦酸盐，唑来膦酸可能更常见。胃肠道效应仅发生于口服制剂（氯膦酸盐和伊班膦酸盐），遵循给药说明可避免。最近，ONJ已成为双膦酸盐使用的一种并发症。然而，其真实发生率尚不清楚。在为转移性骨病选择双膦酸盐时，应根据个体患者的特征和偏好考虑双膦酸盐的潜在不良反应。
