SHOULD BISPHOSPHONATES BE PART OF THE STANDARD THERAPY OF PATIENTS WITH MULTIPLE-MYELOMA OR BONE METASTASES FROM OTHER CANCERS - AN EVIDENCE-BASED REVIEW

Purpose: To review objectively the evidence for the use of bisphosphon ates for the reduction of skeletal events or the management of pain du e to multiple myeloma or bone metastases from other types of cancer. M ethods: MEDLINE was searched from 1976 onwards using the MeSH terms '' exp diphosphonates/,'' ''exp bone neoplasms/,'' ''exp multiple myeloma /,'' and ''bone metastases'' as text words. Bibliographies of reports on these topics and major medical and scientific journals were searche d. Experts in the field were approached. The question was defined and the evidence stratified in a hierarchical manner according to classifi cation of study design. There were sufficient studies to enable the us e of randomized trials only to address the questions. Effectiveness wa s defined and the evidence reviewed in a systematic manner. Results an d Conclusion: Eighteen randomized trials were identified. No meta-anal yses are available. There is level I evidence (defined as an appropria tely conducted randomized clinical trial with a statistically signific ant result) for the use of bisphosphonates to reduce both skeletal eve nts and pain in multiple myeloma and in breast cancer patients with me tastatic bone disease. There is also level I evidence for their use as part of a pain management program for bone metastases from carcinoma of the breast, lung, and prostate, and for symptomatic myeloma. The bi sphosphonates appear to be well tolerated. (C) 1998 by American Societ y of Clinical Oncology.