Paterson A H, Kanis J A, Powles T J, McCloskey E, Hanson J, Ashley S
Division of Medical Oncology, University of Calgary, Alberta.
Can J Oncol. 1995 Dec;5 Suppl 1:54-7.
Clinical research over the last decade has confirmed the helpful role of bisphosphonates in the management of patients with bone metastases secondary to breast cancer and other malignancies. This role is also expanding in myeloma and in the management of osteoporosis. Current clinical research in oncology is focusing on their potential for the prevention of skeletal complications of malignant disease and the development of bone metastases while basic researchers are developing compounds of higher potency and, perhaps, higher therapeutic efficacy. One of the earliest agents to be investigated, etidronate, is effective in the management of malignant hypercalcemia and, when used orally and intermittently, results in reduced bone loss in osteoporosis. However, it does not appear to reduce pain in patients with malignant disease. Clodronate has been shown to be an effective agent in the management of hypercalcemia and can be used as a single intravenous infection for this purpose. Clodronate is also effective in some patients in reducing bone pain and improving mobility. When used orally, it can, as can pamidronate, reduce the skeletal complications of breast cancer such as hypercalcemia, bone fractures and bone pain. It may have fewer gastrointestinal side effects than oral pamidronate. There is emerging evidence that bisphosphonates may delay or prevent the clinical appearance of bone metastases as well as reduce other skeletal complications. Trials of adjuvant bisphosphonates such as clodronate and pamidronate in operable breast cancer are currently under way in Europe and North America.
过去十年的临床研究证实了双膦酸盐在治疗继发于乳腺癌和其他恶性肿瘤的骨转移患者中的有益作用。这一作用在骨髓瘤和骨质疏松症的治疗中也在不断扩大。目前肿瘤学领域的临床研究聚焦于其预防恶性疾病骨骼并发症及骨转移发生的潜力，而基础研究人员正在研发效力更高、或许疗效也更高的化合物。最早被研究的药物之一依替膦酸，对治疗恶性高钙血症有效，口服并间歇使用时，可减少骨质疏松症患者的骨质流失。然而，它似乎并不能减轻恶性疾病患者的疼痛。氯膦酸盐已被证明是治疗高钙血症的有效药物，可单次静脉注射用于此目的。氯膦酸盐在一些患者中还能有效减轻骨痛并改善活动能力。口服时，它与帕米膦酸盐一样，可减少乳腺癌的骨骼并发症，如高钙血症、骨折和骨痛。它的胃肠道副作用可能比口服帕米膦酸盐更少。越来越多的证据表明，双膦酸盐可能会延迟或预防骨转移的临床出现，并减少其他骨骼并发症。目前在欧洲和北美正在进行关于氯膦酸盐和帕米膦酸盐等辅助性双膦酸盐在可手术乳腺癌中的试验。
