Hu Xiao-ye, Zou Qing-feng, Jin Chuan, Li Wei-dong, Chen Wen-sheng, Ma Lei
Department of Medical Oncology, Tumor Hospital of Guangzhou Medical College, Guangzhou 510095, China.
Nan Fang Yi Ke Da Xue Xue Bao. 2010 Jun;30(6):1343-6.
To evaluate the clinical efficacy of zoledronic acid combined with chemotherapy in the management of skeletal metastasis of non-small cell lung cancer (NSCLC) and investigate the value in urine amino-terminal telopeptide of type I collagen (uNTX) and serum bone specific alkaline phosphatase (sBALP) in monitoring skeletal metastasis of NSCLC.
From February, 2007 to January, 2009, 32 NSCLC patients with bone metastases received treatment with zoledronic acid at the dose of 4 mg given every 3 weeks and platinum-based chemotherapy (each cycle lasting for 3 weeks). Before and during the treatments, uNTX and sBALP were measured in these patients using ELISA and precipitation with wheat germ lectin, respectively. The patients were followed up for skeletal-related events (SREs) and status of survival.
A significant decrease occurred in the pain scores and analgesic use in the patients after the therapy. SREs were not observed during the treatment. Serum creatinine and calcium levels underwent no significant variation during the treatment. Eleven patients reported 14 possible zoledronic acid-related adverse events. The concentration of uNTX and sBALP in patients with bone metastases was above the upper limit of the normal range. A positive correlation was observed between the levels of the markers and the extent of bone metastases. At the third month, uNTX and sBALP were significantly lowered, but radionuclide whole-body bone imaging showed no obvious changes. Of the 32 patients, 24 had elevated uNTX values, which became normal after the treatment in 15 patients and remained elevated in the other 9 patients. SREs occurred in these two subgroups at the rates of 53% and 89% (P=0.039), respectively. Twenty-six patients had elevated sBALP level, and 16 of them exhibited normal sBALP level after the treatment. The incidences of SREs in the patients with elevated and normal sBALP level were 50% and 90% (P=0.038), respectively. The levels of uNTX/Cr and sBALP were not correlated to the survival of the patients.
Zoledronic acid combined with chemotherapy is an effective treatment for NSCLC with bone metastases. Zoledronic acid is safe and well tolerated. Urinary NTX and serum BALP have a high value in the diagnosis, therapeutic effect monitoring and SRE prediction of NSCLC with bone metastases.
评估唑来膦酸联合化疗治疗非小细胞肺癌（NSCLC）骨转移的临床疗效，并探讨尿I型胶原氨基端肽（uNTX）和血清骨特异性碱性磷酸酶（sBALP）在监测NSCLC骨转移中的价值。
2007年2月至2009年1月，32例NSCLC骨转移患者接受唑来膦酸治疗，剂量为4mg，每3周一次，同时接受铂类化疗（每个周期持续3周）。治疗前及治疗期间，分别采用酶联免疫吸附测定法（ELISA）和麦胚凝集素沉淀法检测患者的uNTX和sBALP。对患者进行骨相关事件（SREs）及生存状态随访。
治疗后患者疼痛评分及镇痛药使用量显著降低。治疗期间未观察到SREs。治疗期间血清肌酐和钙水平无明显变化。11例患者报告了14例可能与唑来膦酸相关的不良事件。骨转移患者的uNTX和sBALP浓度高于正常范围上限。标志物水平与骨转移程度呈正相关。第三个月时，uNTX和sBALP显著降低，但放射性核素全身骨显像无明显变化。32例患者中，24例uNTX值升高，其中15例治疗后恢复正常，9例仍升高。这两个亚组的SREs发生率分别为53%和89%（P = 0.039）。26例患者sBALP水平升高，其中16例治疗后sBALP水平恢复正常。sBALP水平升高和正常的患者中SREs发生率分别为50%和90%（P = 0.038）。uNTX/Cr和sBALP水平与患者生存无关。
唑来膦酸联合化疗是治疗NSCLC骨转移的有效方法。唑来膦酸安全且耐受性良好。尿NTX和血清BALP在NSCLC骨转移的诊断、疗效监测及SREs预测中具有较高价值。
