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Related Experiment Videos

Bisphosphonates for breast cancer.

N Pavlakis1, M Stockler

  • 1Department of Medical Oncology (Faculty of Medicine), Royal North Shore Hospital (University of Sydney), Pacific Highway, St Leonards, NSW, Australia, 2065. pavlakis@med.usyd.edu.au

The Cochrane Database of Systematic Reviews
|March 1, 2002
PubMed
Summary

Bisphosphonates significantly reduce skeletal events and bone pain in women with advanced breast cancer and bone metastases. Their effectiveness in early breast cancer requires further research.

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Area of Science:

  • Oncology
  • Pharmacology
  • Clinical Trials

Background:

  • Breast cancer commonly metastasizes to bone, causing significant morbidity and mortality.
  • Bone metastases lead to pain, fractures, hypercalcemia, and spinal cord compression.
  • Bisphosphonates inhibit osteoclast activity and are standard for hypercalcemia, also showing benefits in multiple myeloma.

Purpose of the Study:

  • To systematically review evidence on bisphosphonates' effects on skeletal events, pain, quality of life, and survival in early and advanced breast cancer.
  • To summarize high-quality randomized controlled trials (RCTs) evaluating bisphosphonate therapy.

Main Methods:

  • Systematic review of RCTs identified through comprehensive database searches and hand-searches.
  • Inclusion criteria: RCTs comparing bisphosphonates with placebo or no bisphosphonate, or comparing different bisphosphonates.

Related Experiment Videos

  • Data extraction and quality assessment by two independent reviewers, with meta-analysis using a fixed-effects model.

    • Main Results:

    • In advanced breast cancer with bone metastases, bisphosphonates reduced skeletal event risk by 14% (RR 0.86).
    • Oral bisphosphonates reduced skeletal event risk by 17%; intravenous pamidronate at 90 mg showed the greatest risk reduction.
    • Bisphosphonates improved pain and quality of life in some studies but did not affect overall survival.
    • Limited evidence suggests oral clodronate may reduce bone metastases in early breast cancer, but with significant heterogeneity.

    Conclusions:

    • Bisphosphonates are effective in reducing skeletal events and potentially bone pain in advanced breast cancer with bone metastases.
    • Their role in early breast cancer, particularly regarding bone metastases incidence, warrants further investigation.
    • Bisphosphonates are generally well-tolerated with few reported adverse events.