New
Bisphosphonate Reduces Bone Complications in Patients with
Metastatic Breast Cancer
According to a recent article published in the British Journal
of Cancer, the bisphosphonate ibandronate (Boniva™)
reduces skeletal complications in patients with metastatic
breast cancer that has spread to the bone.
As breast cancer becomes more advanced, it tends to spread
throughout the body, with the bones being a common site of
spread. Spread of cancer to the bone from its original site
is referred to as bone metastases. Through complex biological
pathways, bone metastases severely reduce the quality of life
of a patient and may ultimately cause debilitating bone pain,
bone fractures, spinal compression (a life-threatening condition)
and/or abnormalities in calcium levels in the blood. Treatment
for bone metastases is aimed primarily at reducing pain, delaying
the time to fractures or reversing hypercalcemia (high levels
of calcium in the blood). Treatment may consist of radiation
therapy, bisphosphonates, hormone therapy, surgery, and/or
chemotherapy, depending upon the type of cancer from which
the metastasis originated and prior treatment. Besides the
physical sequelae that can be caused by bone metastasis, such
as bone fractures, the pain that it can cause may literally
force patients to become bedridden. Researchers are evaluating
ways in which to prevent or reduce the pain or fractures caused
by bone metastasis, not just provide treatment once they occur.
Bisphosphonates are a class of drugs used for the treatment
of cancer-related hypercalcemia (high levels of calcium in
the blood) and treatment of bone metastases in patients with
advanced cancers. Bisphosphonates decrease the rate of bone
destruction in patients with bone metastases and clinical
studies have demonstrated that bisphosphonates can significantly
decrease the pain and number of fractures occurring from bone
metastases. Research involving bisphosphonates is ongoing,
as physicians are trying to determine the optimal timing of
treatment with bisphosphonates in the course of cancer. In
November 2003, the American Society of Clinical Oncology recommended
the use of the bisphosphonates Zometa ® or Aredia ®
for treatment of patients with bone metastasis from breast
cancer. The role of bisphosphonates, in terms of their optimal
duration of use, or the optimal time in the course of disease
to initiate their use, is still being evaluated in clinical
trials. Researchers are hopeful that bisphosphonates may help
to prevent some patients from developing bone metastasis if
they are administered prior to bone spread; however, results
from clinical trials addressing this question will be the
only way to answer this question.
Boniva™ is a third-generation bisphosphonate that may
be administered into a vein (intravenous), or orally. Both
Zometa ® and Aredia ® can only be administered intravenously,
resulting in increased patient and healthcare providers’
time and resources for administration, as well as increased
pain and potential for infection compared to oral administration.
Currently, Boniva™ is approved for the prevention and
treatment of post-menopausal osteoporosis.
Researchers from Europe recently pooled data from 2 clinical
trials evaluating the oral form of Boniva™. The trials
included 287 women with bone metastasis from breast cancer.
Patients were treated with either Boniva™ or placebo
(inactive substitute) and were evaluated for bone complications
(e.g. bone fractures, spinal cord compression) in 12-week
periods. Patients treated with Boniva™ had significantly
fewer bone complications, and a significantly reduced need
for radiation and/or surgery for the treatment of bone metastasis.
Patients treated with Boniva™ had a slight increase
in mild gastrointestinal disturbances compared to those who
received placebo.
The researchers concluded that Boniva™ reduces bone
complications and the need for radiation or surgery for bone
metastasis in patients with bone metastasis from breast cancer.
In addition, Boniva™ appeared very well tolerated, and
is convenient for patients and healthcare providers as it
is available in oral form. Patients with bone metastasis from
breast cancer may wish to speak with their physician about
the risks and benefits of participating in a clinical trial
further evaluating Boniva™ or other therapeutic options.
Two sources of information regarding ongoing clinical trials
include the National Cancer Institute ( cancer.gov) and www.cancerconsultants.com.
Personalized clinical trial searches are also performed on
behalf of patients at cancerconsultants.com.
Reference: Body JJ, Diel IJ, Lichinitzer M, et al. Oral Ibandronate
Reduces the Risk of Skeletal Complications in Breast Cancer
Patients with Metastatic Bone disease: Results from Two Randomized,
Placebo-Controlled Phase III studies. British Journal of Cancer.
2004;90:1133-1137.
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