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A class of bone-strengthening drugs can have significant benefits for cancer patients whose disease has spread to the bone, according to a review published in the British Medical Journal (Vol. 327, No. 7413: 469-472).
The drugs, called bisphosphonates, significantly reduce fractures, abnormally high concentrations of calcium (hypercalcemia), and the need for radiation (often used to relieve pain). The drugs also delayed the onset of these problems, researchers at London's Royal Marsden Hospital found.
"Clearly a reduction in fractures, need for additional hospital treatment, or pain would be expected to improve a patient's quality of life," said lead researcher JR Ross, research fellow and specialist registrar in the department of palliative medicine.
Most of the patients studied had breast cancer that had spread to bones or multiple myeloma, a cancer that begins in bones. Bisphosphonate treatment of patients with these conditions has become standard practice in the United States.
Fewer Complications
Ross and her colleagues analyzed the results of 30 studies of bisphosphonate treatment for bone metastases. The drugs did not help patients live longer, but did help them have fewer complications from advanced cancer.
Overall, patients who received the drugs had a 31% lower risk of having a fracture in a vertebra, and a 35% lower chance of breaking other bones, when compared to patients given a placebo. Their risk of hypercalcemia was 45% lower, and their risk of needing radiation treatment 33% lower.
Those findings suggest patients with other types of cancer that has spread to the bone could also benefit from this therapy, Ross said.
Herman Kattlove, MD, a medical editor with the American Cancer Society, agreed that the drugs might help a broader range of patients whose bones have been weakened by metastases, but noted that "these situations just haven't been well-studied."
Drugs Take Time to Work
Ross' analysis showed that it can take months for these beneficial effects to be seen, although pain relief is usually quicker.
Patients had to take bisphosphonates for at least six months to see any decrease in the need for radiation treatment or in cases of excessive calcium. To have an impact on broken bones, patients had to take the drugs for a year.
Because of that time frame, Ross and colleagues recommend that bisphosphonate treatment begin at the first indication that cancer has spread to the bone, rather than waiting for symptoms like pain to appear.
"To obtain maximum benefit, it's important to continue reloading the bone with the drug," she said.