Guidance on the use of bisphosphonates in solid tumours: Recommendations of an international expert panel

M. Aapro, P. A. Abrahamsson, J. J. Body, R. E. Coleman, R. Colomer, L. Costa, L. Crinò, L. Dirix, M. Gnant, J. Gralow, P. Hadji, G. N. Hortobagyi, W. Jonat, A. Lipton, A. Monnier, A. H.G. Paterson, R. Rizzoli, F. Saad, B. Thürlimann

Research output: Contribution to journalReview article

372 Citations (Scopus)

Abstract

Bisphosphonates (BP) prevent, reduce, and delay cancer-related skeletal complications in patients, and have substantially decreased the prevalence of such events since their introduction. Today, a broad range of BP with differences in potency, efficacy, dosing, and administration as well as approved indications is available. In addition, results of clinical trials investigating the efficacy of BP in cancer treatment-induced bone loss (CTIBL) have been recently published. The purpose of this paper is to review the current evidence on the use of BP in solid tumours and provide clinical recommendations. An interdisciplinary expert panel of clinical oncologists and of specialists in metabolic bone diseases assessed the widespread evidence and information on the efficacy of BP in the metastatic and nonmetastatic setting, as well as ongoing research on the adjuvant use of BP. Based on available evidence, the panel recommends amino-bisphosphonates for patients with metastatic bone disease from breast cancer and zoledronic acid for patients with other solid tumours as primary disease. Dosing of BP should follow approved indications with adjustments if necessary. While i.v. administration is most often preferable, oral administration (clodronate, IBA) may be considered for breast cancer patients who cannot or do not need to attend regular hospital care. Early-stage cancer patients at risk of developing CTIBL should be considered for preventative BP treatment. The strongest evidence in this setting is now available for ZOL. Overall, BP are well-tolerated, and most common adverse events are influenza-like syndrome, arthralgia, and when used orally, gastrointestinal symptoms. The dose of BP may need to be adapted to renal function and initial creatinine clearance calculation is mandatory according to the panel for use of any BP. Subsequent monitoring is recommended for ZOL and PAM, as described by the regulatory authority guidelines. Patients scheduled to receive BP (mainly every 3-4 weeks i.v.) should have a dental examination and be advised on appropriate measures for reducing the risk of jaw osteonecrosis. BP are well established as supportive therapy to reduce the frequency and severity of skeletal complications in patients with bone metastases from different cancers.

Original languageEnglish (US)
Pages (from-to)420-432
Number of pages13
JournalAnnals of Oncology
Volume19
Issue number3
DOIs
StatePublished - Mar 2008

Fingerprint

Diphosphonates
Neoplasms
zoledronic acid
Bone and Bones
Clodronic Acid
Breast Neoplasms
Social Adjustment
Osteonecrosis
Metabolic Bone Diseases
Bone Diseases
Arthralgia
Therapeutics
Jaw
Human Influenza
Oral Administration
Creatinine
Tooth

All Science Journal Classification (ASJC) codes

  • Hematology
  • Oncology

Cite this

Aapro, M., Abrahamsson, P. A., Body, J. J., Coleman, R. E., Colomer, R., Costa, L., ... Thürlimann, B. (2008). Guidance on the use of bisphosphonates in solid tumours: Recommendations of an international expert panel. Annals of Oncology, 19(3), 420-432. https://doi.org/10.1093/annonc/mdm442
Aapro, M. ; Abrahamsson, P. A. ; Body, J. J. ; Coleman, R. E. ; Colomer, R. ; Costa, L. ; Crinò, L. ; Dirix, L. ; Gnant, M. ; Gralow, J. ; Hadji, P. ; Hortobagyi, G. N. ; Jonat, W. ; Lipton, A. ; Monnier, A. ; Paterson, A. H.G. ; Rizzoli, R. ; Saad, F. ; Thürlimann, B. / Guidance on the use of bisphosphonates in solid tumours : Recommendations of an international expert panel. In: Annals of Oncology. 2008 ; Vol. 19, No. 3. pp. 420-432.
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Aapro, M, Abrahamsson, PA, Body, JJ, Coleman, RE, Colomer, R, Costa, L, Crinò, L, Dirix, L, Gnant, M, Gralow, J, Hadji, P, Hortobagyi, GN, Jonat, W, Lipton, A, Monnier, A, Paterson, AHG, Rizzoli, R, Saad, F & Thürlimann, B 2008, 'Guidance on the use of bisphosphonates in solid tumours: Recommendations of an international expert panel', Annals of Oncology, vol. 19, no. 3, pp. 420-432. https://doi.org/10.1093/annonc/mdm442

Guidance on the use of bisphosphonates in solid tumours : Recommendations of an international expert panel. / Aapro, M.; Abrahamsson, P. A.; Body, J. J.; Coleman, R. E.; Colomer, R.; Costa, L.; Crinò, L.; Dirix, L.; Gnant, M.; Gralow, J.; Hadji, P.; Hortobagyi, G. N.; Jonat, W.; Lipton, A.; Monnier, A.; Paterson, A. H.G.; Rizzoli, R.; Saad, F.; Thürlimann, B.

In: Annals of Oncology, Vol. 19, No. 3, 03.2008, p. 420-432.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Guidance on the use of bisphosphonates in solid tumours

T2 - Recommendations of an international expert panel

AU - Aapro, M.

AU - Abrahamsson, P. A.

AU - Body, J. J.

AU - Coleman, R. E.

AU - Colomer, R.

AU - Costa, L.

AU - Crinò, L.

AU - Dirix, L.

AU - Gnant, M.

AU - Gralow, J.

AU - Hadji, P.

AU - Hortobagyi, G. N.

AU - Jonat, W.

AU - Lipton, A.

AU - Monnier, A.

AU - Paterson, A. H.G.

AU - Rizzoli, R.

AU - Saad, F.

AU - Thürlimann, B.

PY - 2008/3

Y1 - 2008/3

N2 - Bisphosphonates (BP) prevent, reduce, and delay cancer-related skeletal complications in patients, and have substantially decreased the prevalence of such events since their introduction. Today, a broad range of BP with differences in potency, efficacy, dosing, and administration as well as approved indications is available. In addition, results of clinical trials investigating the efficacy of BP in cancer treatment-induced bone loss (CTIBL) have been recently published. The purpose of this paper is to review the current evidence on the use of BP in solid tumours and provide clinical recommendations. An interdisciplinary expert panel of clinical oncologists and of specialists in metabolic bone diseases assessed the widespread evidence and information on the efficacy of BP in the metastatic and nonmetastatic setting, as well as ongoing research on the adjuvant use of BP. Based on available evidence, the panel recommends amino-bisphosphonates for patients with metastatic bone disease from breast cancer and zoledronic acid for patients with other solid tumours as primary disease. Dosing of BP should follow approved indications with adjustments if necessary. While i.v. administration is most often preferable, oral administration (clodronate, IBA) may be considered for breast cancer patients who cannot or do not need to attend regular hospital care. Early-stage cancer patients at risk of developing CTIBL should be considered for preventative BP treatment. The strongest evidence in this setting is now available for ZOL. Overall, BP are well-tolerated, and most common adverse events are influenza-like syndrome, arthralgia, and when used orally, gastrointestinal symptoms. The dose of BP may need to be adapted to renal function and initial creatinine clearance calculation is mandatory according to the panel for use of any BP. Subsequent monitoring is recommended for ZOL and PAM, as described by the regulatory authority guidelines. Patients scheduled to receive BP (mainly every 3-4 weeks i.v.) should have a dental examination and be advised on appropriate measures for reducing the risk of jaw osteonecrosis. BP are well established as supportive therapy to reduce the frequency and severity of skeletal complications in patients with bone metastases from different cancers.

AB - Bisphosphonates (BP) prevent, reduce, and delay cancer-related skeletal complications in patients, and have substantially decreased the prevalence of such events since their introduction. Today, a broad range of BP with differences in potency, efficacy, dosing, and administration as well as approved indications is available. In addition, results of clinical trials investigating the efficacy of BP in cancer treatment-induced bone loss (CTIBL) have been recently published. The purpose of this paper is to review the current evidence on the use of BP in solid tumours and provide clinical recommendations. An interdisciplinary expert panel of clinical oncologists and of specialists in metabolic bone diseases assessed the widespread evidence and information on the efficacy of BP in the metastatic and nonmetastatic setting, as well as ongoing research on the adjuvant use of BP. Based on available evidence, the panel recommends amino-bisphosphonates for patients with metastatic bone disease from breast cancer and zoledronic acid for patients with other solid tumours as primary disease. Dosing of BP should follow approved indications with adjustments if necessary. While i.v. administration is most often preferable, oral administration (clodronate, IBA) may be considered for breast cancer patients who cannot or do not need to attend regular hospital care. Early-stage cancer patients at risk of developing CTIBL should be considered for preventative BP treatment. The strongest evidence in this setting is now available for ZOL. Overall, BP are well-tolerated, and most common adverse events are influenza-like syndrome, arthralgia, and when used orally, gastrointestinal symptoms. The dose of BP may need to be adapted to renal function and initial creatinine clearance calculation is mandatory according to the panel for use of any BP. Subsequent monitoring is recommended for ZOL and PAM, as described by the regulatory authority guidelines. Patients scheduled to receive BP (mainly every 3-4 weeks i.v.) should have a dental examination and be advised on appropriate measures for reducing the risk of jaw osteonecrosis. BP are well established as supportive therapy to reduce the frequency and severity of skeletal complications in patients with bone metastases from different cancers.

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U2 - 10.1093/annonc/mdm442

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