Fitting new modalities into practice guidelines.

At M. D. Anderson, the use of the recently approved bisphosphonate pamidronate (Aredia) became a part of the standard of care pathway for the treatment of osteolytic metastases from breast cancer. How any agent achieves that status involves the long process of completing clinical trials and resolving many practical and ethical dilemmas. What criteria determine the standard of care and who decides what those criteria should be are two of the many questions that need to be answered before a treatment modality or specific agent becomes part of the standard of care. This article describes how pamidronate achieved that status at M. D. Anderson.