Renal Safety and Efficacy of i.v. Bisphosphonates in Patients with Skeletal Metastases Treated for up to 10 Years

Guarneri, Valentina; Donati, Sara; Nicolini, Massimiliano; Giovannelli, Simona; D'Amico, Roberto; Conte, Pierfranco

doi:10.1634/theoncologist.10-10-842

Cited by 80 publications

(50 citation statements)

References 24 publications

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“…The same pattern was seen among patients receiving anti-angiogenic therapy in the current analysis: the incidence of ONJ was 0.9-2.4% in bevacizumab-treated patients who had been exposed to bisphosphonates (Table 1) compared with 0.0-0.2% in patients who had not received bisphosphonates. The 0.9-2.4% incidence in patients exposed to bisphosphonates is within the 1-6% range reported for bisphosphonates alone in large studies [7,8,[10][11][12][13][14][15]. There was no consistent pattern in the timing of onset of ONJ.…”

Section: Discussionmentioning

confidence: 51%

“…ONJ is typically associated with intravenous bisphosphonate use. Among patients receiving bisphosphonates (without anti-angiogenic therapy), the reported incidence of ONJ ranges from 1 to 6% [7,8,[10][11][12][13][14][15]. An additional trigger factor, such as previous tooth extraction, surgical dental procedures or Actinomyces infection, is often reported in patients developing ONJ [7,12,16].…”

Section: Introductionmentioning

confidence: 99%

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Bevacizumab and osteonecrosis of the jaw: incidence and association with bisphosphonate therapy in three large prospective trials in advanced breast cancer

Guarneri

Miles

Robert³

et al. 2010

Breast Cancer Res Treat

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Long-term bisphosphonate therapy is associated with increased risk of osteonecrosis of the jaw (ONJ). In a retrospective analysis, a 16% ONJ incidence was reported in patients receiving bisphosphonates with antiangiogenic therapy (bevacizumab or sunitinib) for bone metastases from breast, colon, or renal cell cancers. To assess ONJ incidence with bevacizumab, we analysed data from 3,560 patients receiving bevacizumab-containing therapy for locally recurrent or metastatic breast cancer (LR/MBC) in two double-blind, randomised trials (AVADO and RIBBON-1) and a large, non-randomised safety study (ATHENA). The overall incidence of ONJ with bevacizumab was 0.3% in the blinded phase of the two randomised trials and 0

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Section: Discussionmentioning

confidence: 51%

Section: Introductionmentioning

confidence: 99%

Bevacizumab and osteonecrosis of the jaw: incidence and association with bisphosphonate therapy in three large prospective trials in advanced breast cancer

Guarneri

Miles

Robert³

et al. 2010

Breast Cancer Res Treat

Self Cite

242

150

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“…Four of the six ONJ patients received prolonged treatment (median exposure time of case series, 22 months). A number of other works report results from retrospective analyses, with an estimated incidence varying in the range of 0.8%-5.2% [25][26][27][28]. These widely differing incidence rates could be a result of the different number of patients involved in each study, the length of exposure, a variety of other possible risk factors, or the different follow-up times observed.…”

Section: Discussionmentioning

confidence: 99%

Osteonecrosis of the Jaw in Patients with Bone Metastases Treated with Bisphosphonates: A Retrospective Study

et al. 2008

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After completing this course, the reader will be able to:1. Discuss the importance of treating patients with bone metastases using a multidisciplinary approach.2. Explain why bisphosphonates are a fundamental part of bone metastasis treatment.3. Evaluate the main features of ONJ and, in particular, its high risk factor. 4. Describe the importance of ONJ prevention during bisphosphonate treatment.5. Emphasize the importance of interaction among the patient's dentist, surgeon, and oncologist for the management of ONJ.Access and take the CME test online and receive 1 AMA PRA Category 1 Credit ™ at CME.TheOncologist.com CME CME Results. The eight patients with ONJ had all been given zoledronic acid, and two had also been treated with pamidronic acid. In four of the patients, ONJ was diagnosed during treatment, while in the remaining four it was diagnosed several months after therapy with bisphosphonates had ended. Six of these patients received local noninvasive treatment, of whom five progressed. Two showed apparent autolimitation of the disease. The remaining two patients underwent surgical resection and currently show no signs of relapse. All eight ONJ patients presented with various concomitant risk factors such as paradontopathy, dental extraction, or spontaneous avulsion. ABSTRACTConclusions. Our results show that ONJ can appear months after interruption of treatment and that a surgical approach can be used in suitable cases. Closer cooperation is needed among specialists to define guidelines for the prevention of ONJ in patients with bone metastases. The Oncologist 2008;13:330 -336

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“…19,20 In contrast to those studies, we evaluated IBP use among a more diverse patient population with a higher percentage of males diagnosed with multiple myeloma and a larger representation of minorities. This is an important distinction considering the possible confounders of gender and underlying diseases on skeletal morbidity.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of intravenous bisphosphonates beyond two years

Gilliam¹,

Winters²,

McGuire³

et al. 2010

IJO

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Background: Metastatic bone disease, a common complication of malignancy, causes significant morbidity in affected patients. Intravenous bisphosphonates (IBPs) have shown efficacy in preventing skeletal morbidity, however few studies have investigated their efficacy and safety in cancer patients beyond 2 years of use. This retrospective study documents long term clinical use of IBPs among a variety of patient populations and clinical settings. Methods: This study is a multi-center retrospective chart review of patients who received IBPs (Pamidronate or Zoledronic Acid) for more than 24 months. Patients were at least 18 years of age and had tumor-associated bone disease. Data analysis focused on skeletal related events (SREs) and drug related toxicities such as renal failure and osteonecrosis of the jaw (ONJ). Results: Ninety-two patients were included with the most common diagnosis being multiple myeloma. A total of 44 SREs occurred among 23 patients. Mean time to first SRE was 515 days. The rate of skeletal events in the first 2 years of treatment was 0.70, while skeletal morbidity rate (SMR) in subsequent years was 0.16. Thirteen patients experienced renal toxicity; most patients' renal function normalized after brief or permanent cessation of IBP therapy. ONJ was associated with 5 patients. Conclusion: Continuation of IBP therapy for skeletal metastasis after 2 years of treatment may improve skeletal morbidity. Similar to the first 2 years of treatment, significant toxicities such as renal failure and ONJ are uncommon.

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Renal Safety and Efficacy of i.v. Bisphosphonates in Patients with Skeletal Metastases Treated for up to 10 Years

Cited by 80 publications

References 24 publications

Bevacizumab and osteonecrosis of the jaw: incidence and association with bisphosphonate therapy in three large prospective trials in advanced breast cancer

Bevacizumab and osteonecrosis of the jaw: incidence and association with bisphosphonate therapy in three large prospective trials in advanced breast cancer

Osteonecrosis of the Jaw in Patients with Bone Metastases Treated with Bisphosphonates: A Retrospective Study

Efficacy and safety of intravenous bisphosphonates beyond two years

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