The role of disodium pamidronate in the management of bone pain due to malignancy

A number of controlled studies have recently demonstrated the role of disod ium pamidronate in the prevention of skeletal complications in patients wit h metastatic bone disease due to breast cancer and multiple myeloma. They h ave also shown that it relieves pain and is well tolerated. The aim of this open prospective study was to evaluate the acceptability of a new schedule of pamidronate infusion and to assess pain, analgesic consu mption and the Karnofsky Performance Status (KPS) in patients with metastat ic bone pain treated with pamidronate in association or not with chemothera py, radiotherapy, and hormone therapy. Patients with different types of can cer and at least one painful bone metastasis were treated with two cycles o f 60 mg intravenous (iv) pamidronate weekly for three consecutive doses, wi th a 3-week interval between the two cycles (six infusions over 7 weeks), f ollowed by one infusion every 3 weeks for a total of 24 infusions. Two hund red patients were enrolled in the study, of whom 94 received at least the f irst six infusions; 25 patients received all 24 infusions. Pamidronate was well tolerated in the majority of the patients both during the first six infusions and during the whole study period. In the patients under study, pain intensity decreased compared with T-0 aft er the first two infusions (second week of treatment). The mean equivalent daily dose of oral morphine required ranged from 21.5 to 41.5 mg/day and wa s low and stable during the study. For the patients who remained in the stu dy, the KPS remained around 70 during the whole treatment period and intras ubject analysis showed a substantial stability of the KPS within each subje ct. A first fracture occurred within 321 days in 25% of the whole population un der study. Pamidronate represents a further valid therapy to add to an already consoli dated list of therapies such as radiotherapy, chemotherapy, hormone therapy and orthopaedic intervention in the pain management of patients with bone metastases. Future studies are necessary to evaluate the role of pamidronat e and the appropriate schedule in patients with advanced or terminal cancer who are no longer being treated with oncological therapies.