Zoledronic acid is superior to pamidronate in the treatment of hypercalcemia of malignancy: A pooled analysis of two randomized, controlled clinical trials

Purpose: Two identical, concurrent, parallel, multicenter, randomized, doub le-blind, double-dummy trials were conducted to compare the efficacy and sa fety of zoledronic acid and pamidronate for treating hypercalcemia of malig nancy (HCM). Patients and Methods: Patients with moderate to severe HCM (corrected serum calcium [CSC] greater than or equal to 3.00 mmol/L [12.0 mg/dL]) were trea ted with a single dose of zoledronic acid (4 or 8 mg) via 5-minute infusion or pamidronate (90 mg) via 2-hour infusion. A protocol-specified pooled an alysis of the two parallel trials was performed. Clinical end points includ ed rate of complete response by day 10, response duration, and time to rela pse. Results: Two hundred eighty-seven patients were randomized and evaluated fo r safety,. 275 were evaluated for efficacy. Both doses of zoledronic acid w ere superior to pamidronate in the treatment of HCM. The complete response rates by day 10 were 88.4% (P =.002), 86.7% (P =.015), and 69.7% for zoledr onic acid 4 mg and 8 mg and pamidronate 90 mg, respectively. Normalization of CSC occurred by day 4 in approximately 50% of patients treated with zole dronic acid and in only 33.3% of the pamidronate-treated patients. The medi an duration of complete response favored zoledronic acid 4 and 8 mg over pa midronate 90 mg with response durations of 32, 43, and 18 days, respectivel y. Conclusion: Zoledronic acid is superior to pamidronate; 4 mg is the dose re commended for initial treatment of HCM and 8 mg for relapsed or refractory hypercalcemia. J Clin Oncol 19:558-567. (C) 2001 by American Society of Cli nical Oncology.