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Breast Cancer
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
Amy Case, Gwenllian Edwards, Catherine Pembroke
It has become standard practice to offer adjuvant bisphosphonates to postmenopausal women with node-positive or node-negative high-risk breast cancer.111,112 Optimal choice of bisphosphonate and dosing strategy is unclear, but as there are most data for zoledronic acid or sodium clodronate, these are favored by both UK NICE and ASCO guidelines. Zoledronic acid is administered 6-monthly for 3–5 years, and clodronate given daily for 2–3 years.
Systemic complications of osteoporosis medical treatment
Published in Peter V. Giannoudis, Thomas A. Einhorn, Surgical and Medical Treatment of Osteoporosis, 2020
Konstantinos G. Makridis, Stamatina-Emmanouela Zourntou
One study reported a case report with systemic inflammatory response after intravenous administration of zoledronic acid. He was a pediatric patient with complex medical problems, and he developed tachycardia, fever, hypotension, moderate acute respiratory distress syndrome, and pulmonary hemorrhage beginning 3 hours after completion of the infusion and resolving the third day (5).
Cancer Pain
Published in Gary W. Jay, Practical Guide to Chronic Pain Syndromes, 2016
Bisphosphonates inhibit osteoclast-mediated bone resorption, thereby reducing pain related to metastatic bone disease. These agents are also used to prevent skeletal complications and to treat hypercalcemia (50, 51). Pamidronate disodium has been shown to reduce pain, hypercalcemia, and skeletal morbidity associated with breast cancer and multiple myeloma. The drug is administered as an intravenous infusion and dosing is generally repeated every four weeks, with an analgesic effect typically seen in two to four weeks. Zoledronic acid has been shown to relieve pain due to metastatic bone disease and is somewhat more convenient in that it can be infused over a shorter duration of time (50). Risedronate, alendronate, and ibandronate are oral formulations taken daily or weekly, weekly, and monthly, respectively. Therapy should be discontinued and parenteral delivery of other agents considered when patients are unable to sit up for at least 30 to 60 minutes after swallowing the tablets.
Acute Bilateral Anterior Uveitis following Cyclophosphamide/ Bortezomid/ Dexamethasone (CyBorD) Protocol in a Newly Diagnosed Multiple Myeloma Patient with Concomitant Use of Zoledronic Acid
Published in Ocular Immunology and Inflammation, 2021
Efthymios Karmiris, Maria-Giannoula Vasilopoulou, Evangelia Chalkiadaki
Zoledronic acid belongs to the bisphosphonate class of drugs, used for metastatic bone disease and osteoporosis. It inhibits bone resorption and has been widely used in oncological problems, including MM, to prevent skeletal-related events. Ocular side effects are reported rarely and may include acute anterior uveitis (usually mild and transient), scleritis, and orbital inflammatory disease. Severe anterior uveitis has been reported with many members of this drug family such as alendronate, pamidronate, and risedronate. Proinflammatory cytokines such as TNF-α and IL-6 may play a role in the pathogenesis of Zoledronic acid-related uveitis. The incidence of acute anterior uveitis severe enough to prompt an eye examination in patients receiving intravenous zoledronate infusions is 0.8%.7 All reported cases with intravenous administration had rapid onset within 24–48 h after initiation of therapy, and good response to topical steroid treatment and bisphosphonate discontinuation. Dose-related correlation has not been reported until now.
Cost-effectiveness of denosumab for the prevention of skeletal-related events in patients with solid tumors and bone metastases in the United States
Published in Journal of Medical Economics, 2020
Alison Stopeck, Adam Brufsky, Lisa Kennedy, Sumi Bhatta, Debajyoti Bhowmik, Jacqueline Buchanan, Nicolas Despiegel, Guy Hechmati
Zoledronic acid is an intravenous bisphosphonate used to delay or prevent bone complications in patients with bone metastases; however, treatment can be associated with renal toxicity, requiring renal function monitoring, and is not recommended in patients with chronic renal impairment17. Denosumab (XGEVA®, Amgen Inc., Thousand Oaks, CA, USA) is a fully human monoclonal antibody against receptor activator of nuclear factor-kappa Β ligand (RANKL) that inhibits osteoclast-mediated bone destruction18. An integrated analysis of data from three identically designed, randomized, double-blind, phase 3 trials of 5,723 patients with bone metastases and breast cancer, prostate cancer, or other solid tumors or multiple myeloma demonstrated that denosumab was superior to zoledronic acid in delaying the time to first SRE (hazard ratio = 0.83 [95% CI = 0.76–0.90])19. The median (95% CI) time to first on-study SRE was 27.7 (24.2–not estimable) months for denosumab and 19.5 (18.5–21.4) months for zoledronic acid, a difference of 8.2 months19. Both drugs are recommended in the current American Society of Clinical Oncology guidelines on the use of bone-modifying agents for patients with bone metastases20.
Monoclonal antibodies against RANKL and sclerostin for myeloma-related bone disease: can they change the standard of care?
Published in Expert Review of Hematology, 2019
Martina Kleber, Ioannis Ntanasis-Stathopoulos, Meletios A. Dimopoulos, Evangelos Terpos
Despite bisphosphonates being the initial choice of treatment, the durability of their use is limited to their side effects. Most relevant adverse effects of bisphosphonates are renal toxicity and osteonecrosis of the jaw (ONJ) [33]; thus, regular monitoring of patients undergoing long-term treatment of bisphosphonates is warranted. Up to 40% of the bisphosphonates are excreted via glomerular filtration and active tubular excretion [69]. While pamidronate induces glomerular damage, zoledronate induces acute tubular necrosis, both potentially resulting in acute renal failure [80]. The nephrotoxicity correlates with dose, time of infusion, and maximum plasma concentration. Zoledronic acid doses should be reduced in patients with creatinine clearance of 30–60 ml/min. Albeit zoledronic acid studies including patients with severe renal impairment have not been performed, there is no recommendation in these patient cohorts. In contrast, pamidronate (90 mg administered over 4–6 h) is recommended in patients with severe renal impairment [81].