The Use of Bisphosphonates in Patients With Breast Cancer

Catherine H. Van Poznak, MD

Disclosures

Cancer Control. 2002;9(6) 

In This Article

Palliative Bone Pain Therapy

Randomized, controlled trials evaluating intra-venous pamidronate, clodronate, ibandronate, and zoledronate have demonstrated that these bisphosphonates aid in the relief of bone pain.[12,14,29,30,31,32] Prolonged administration of oral clodronate (1,600 mg daily) reduces the frequency of morbid skeletal events by more than 25%, although compliance can be a limiting factor with the high oral dose required for this compound.[33,34] Although bisphosphonates have not had an impact on overall survival, they have reduced skeletal complications of breast cancer. In addition, intravenous bisphosphonates have clinically relevant analgesic effects in patients with metastatic bone pain. The current standards of care for cancer pain -- analgesics and local radiation therapy -- should not be displaced by bisphosphonates[26]; bisphosphonates may complement other treatment modalities. Pamidronate has been shown to reduce pain even in patients in whom conventional antineoplastic therapy fails.[35] Bisphosphonates also provide treatment for patients with widespread, poorly localized bone pain and in patients experiencing recurrence of pain in previously irradiated skeletal sites. The pain relief obtained from bisphosphonates can play a role in maintaining patient comfort during palliative care.[36,37] The role of bisphosphonates in the hospice setting needs to be further defined.

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