Bisphosphonates Associated with Fewer Skeletal-Related Events in Patients with Lung Cancer and Bone Metastasis

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(ChemotherapyAdvisor) – Bisphosphanates are associated with fewer and later-onset skeletal-related events (SREs) and better pain control among patients with bone metastasis from lung cancer, according to a meta-analysis of data from 12 controlled clinical trials representing 1,767 patients. The study was published in the journal Supportive Care in Cancer.

Bisphosphonates “reduced SREs and when added to other treatment modalities (e.g., chemotherapy, radiation therapy, and radioisotopic therapy) resulted in better pain control, quality of life, and less progression of bone lesions than other therapies alone,” reported Maria A. Lopez-Olivo, MD, of the MD Anderson Cancer Center's Department of General Internal Medicine, in Houston, Texas, and her colleagues.

Overall, patients receiving zoledronic acid (vs. placebo) were 19% less likely to suffer SREs (RR 0.81 [95% CI: 0.67-0.97]), and zoledronic acid significantly delayed time to first SRE (vs. placebo; median difference, 163 days [95% CI: 45.2-278.8 days]), the authors reported.

“Zoledronic acid did not demonstrate a statistically significant difference in the risk of developing SREs compared to ibandronate,” they wrote. However, patients receiving zoledronic acid developed SREs later than those administered ibandronate (median time to first SRE: 10.2 months vs. 9.4 months; P=0.03).

Bisphosphonates are frequently administered to patients with multiple myeloma, or prostate or breast cancer-related bone metastases, but are “seldom used in patients with lung cancer and metastatic bone disease,” the authors noted.

“Our systematic review and meta-analysis revealed that bisphosphonates can reduce the risk of developing SREs and help control bone pain in these patients,” they concluded.

The authors noted a trend toward improved survival among patients receiving zoledronic acid plus chemotherapy vs. chemotherapy alone. The benefit exceeded 2 months but was based on comparative survival data pooled from only four studies, and the meta-analytic trend did not reach statistical significance (P=0.08).

The most frequent toxicities included transient flu-like and GI symptoms, particularly among patients receiving zoledronic acid. Osteonecrosis of the jaw occurred in 4 of 87 patients (5%) receiving zoledronic acid.

“Renal impairment was reported in up to 15% of patients treated with zoledronic acid,” the authors added. “There were also reports of reversible bone marrow suppression with the combination of clodronate, pamidronate, and zoledronic acid with other therapeutic modalities.”

The authors reported no conflicts of interest. The study was supported in part by a Cancer Center Support Grant from the National Institutes of Health (NIH).


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