Current use of bisphosphonates in oncology

Purpose: The purpose of this article is to review the recent data on bispho sphonate use in oncology and to provide some guidelines on the indications for their use in cancer patients. Design: The group consensus reached by experts on the rationale for the use of bisphosphonates in cancer patients and their current indications for th e treatment of tumor-induced hypercalcemia and metastatic bone pain in adva nced disease and for the prevention of the complications of multiple myelom a and of metastatic bone disease are reviewed. Results: Bisphosphonates are potent inhibitors of tumor-induced osteoclast- mediated bone resorption. They now constitute the standard treatment for ca ncer hypercalcemia, for which we recommend a dose of 1,500 mg of clodronate or 90 mg of pamidronate; the latter compound is more potent and has a long er lasting effect. Intravenous bisphosphonates exert clinically relevant an algesic effects in patients with metastatic bone pain. Regular pamidronate infusions can also achieve a partial objective response by conventional Int ernational Union Against Cancer criteria and enhance the objective response rate to chemotherapy. In breast cancer, the prolonged administration of or al clodronate 1,600 mg daily reduces the frequency of morbid skeletal event s by more than one fourth, whereas monthly pamidronate infusions of 90 mg f or only 1 year in addition to chemotherapy reduce by more than one third th e frequency of all skeletal-related events. The use of bisphosphonates to p revent bone metastases remains experimental. Last, bisphosphonates in addit ion to chemotherapy are superior to chemotherapy alone in patients with sta ges II and III multiple myeloma and can reduce the skeletal morbidity rate by approximately one half. Conclusion: Bisphosphonate use is a major therapeutic advance in the manage ment of the skeletal morbidity caused by metastatic breast cancer or multip le myeloma, although many questions remain unanswered, notably regarding th e optimal selection of patients and the duration of treatment. (C) 1998 by American Society of Clinical Oncology.