Abstract

VIDAL, M. A.; BENITEZ, D.  and  TORRES, L. M.. Clinical implications of zoledronic acid for the treatment of pain. Rev. Soc. Esp. Dolor [online]. 2006, vol.13, n.8, pp.553-560. ISSN 1134-8046.

Introduction: Bone approximately represents 40% of cancer recurrences , with a higher incidence in patients with múltiple myeloma, breast, lung and prostate cancer. Bone pain is the most frequent and considerably affects patients´ life quality. Although resolution is not possible, symptom control is. Biphosphonates are powerful inhibitors of normal and pathological bone resorption and have an important effect on bone metastasis. Zoledronic acid is the most frequently used biphosphonate for this purpose. It has been approved for the prevention of complications related to bone metastasis in multiple myeloma , prostate, breast, lung cancer and other types of solid tumours. It is also approved for the treatment of tumour-induced hypercalcemia. The European Commission has authorized the use of zoledronic acid for the treatment of Paget disease. Effectiveness: Several studies demonstrate the effectiveness of zoledronic acid for the treatment of diverse conditions. In vitro studies showing the antitumour activity of zoledronic acid have been carried out. It has also been shown that it can have an additive or synergistic affect with other antitumour agents. Multiple in vivo studies demostrate that zoledronic acid can inhibit the formation or progression of bone metastasis and reduce the growth of bone tumour. Adverse effects: Biphosphonates can cause renal adverse effects, related to dose and rate of infusion when administered intravenously. In vitro studies demonstrate a better tolerance of zoledronic acid when compared to pamidronate. Clinical trials have shown an acceptable security profile in patients with bone metastasis and hypercalcemia of tumour origin. Reported adverse events were flu-like symptoms, gastrointestinal reactions, anemia, weakness, cough, dyspnea and edema. Cost-effectiveness: The economic cost of cancer-related skeletal complications is very high, also due to the cost of radiotherapy and hospital stay. The great variability of cost in patients with advanced cancer makes the analysis difficult. Discussion: Considering the existing evidence of the antitumour activity of zoledronic acid, it is necessary to elucidate the mechanisms involved and to determine the most effective dose, in order to maximize this potential effect. The objectives that must be considered when bone metastasis are diagnosed should be focused in the most suitable moment to start the treatment with zoledronic acid, as well as its duration depending on the therapeutic answer.

Keywords : Biphosphonates; zoledronic acid; Paget disease; bone metastasis.

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