PubMed2000
BACKGROUND: In recent years, the management of tumor-induced bone lesions has been fundamentally changed by the therapeutic class of the bisphosphonates. TUMOR-INDUCED HYPERCALCEMIA (TIH): This was the first oncological entity to be treated with bisphosphonates. Because of the impaired renal function that always accompanies TIH, bisphosphonates must be infused sufficiently diluted and over a period of 2 to 4 h in this indication. The success rate (normalisation of serum calcium levels) with pamidronate is > 90%. TUMOR-INDUCED OSTEOLYSIS (TIO): Intravenously administered bisphosphonates like pamidronate do not only significantly reduce the rate of complications from TIO, both in breast cancer and multiple myeloma, but they also frequently lead to a remission in bone (sclerosis of the lesion). For the modern amino-bisphosphonates a direct anti-tumoral effect could be shown, too. NEW DEVELOPMENTS: New bisphosphonates of the 3rd generation are under development. Zoledronat, a new chemical entity from Novartis, is currently the most potent bisphosphonate. Clinical studies have shown that zoledronate is significantly more effective than pamidronate in the treatment of HCM. CONCLUSION: Bisphosphonates are today an important part of the standard therapy of tumor-induced bone diseases. Due to their direct anti-tumoral effects, the modern drugs of this class play an increasing role also in the prevention of bone metastases.