ZOLEDRONIC ACID IN METASTATIC BONE DISEASE: AN AUDIT BASED DISCUSSION

Raza Ali Akbar, Sanjib Kumar Ghosh, Sajjad Khalil, Sheikh Moeen-ul-Haq

Abstract


Background: Metastatic bone disease is a common problem in patients with advanced cancer causing
significant morbidity and poor quality of life. Effective and less toxic treatments, like bisphophonates, can
reduce morbidity in such cases. Objectives: The objectives of this study were to determine whether
Zoledronic acid was administered in accordance with current recommendations for its prescribing and to
produce protocols for improved patient outcomes. Methods: The study was a retrospective audit of 39
consecutive patients with metastatic bone disease secondary to solid tumours who were treated with
Zoledronic acid. The records were analysed to establish the administered dose of Zoledronic acid relative
to creatinine clearance. The standards for Zoledronic acid therapy were defined from best practice
guidelines. Results: The commonest diagnosis in patients receiving Zoledronic acid was carcinoma
prostate 19/39 (49%) followed by carcinoma breast 11/39 (28%), gastrointestinal malignancies 4/39
(10%) and renal cell carcinoma 3/39 (8%). Indications for therapy were metastatic bone disease alone 31
(79%), hypercalcaemia alone 0/39 (0%), metastatic bone disease with hypercalcaemia 5/39 (13%), and
prevention of chemotherapy induced bone loss 1/39 (3%). The dose of Zoledronic acid was appropriate to
the creatinine clearance in 25/39 (64%), inappropriate in 5/39 (13%) and unclear from the notes in 9/39
(23%). Conclusions: Majority of patients received Zoledronic acid for the appropriate indications. The
dose of Zoledronic acid was appropriate to serum creatinine clearance in a majority of patients. Poor
documentation of data pertaining to Zoledronic acid treatment is observed which can potentially lead to
major errors in prescribing. We recommend using a standard form to document each episode of therapy
with Zoledronic acid.
Keywords: Zoledronic Acid, Metastatic Bone Disease, Audit

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References


Coleman RE, Rubens RD. The clinical course of bone

metastases from breast cancer. Br J Cancer 1987;55(1):61–6.

Aapro M, Abrahamsson PA, Body JJ, Coleman RE, Colomer

R, Costa L, et al. Guidance on the use of bisphosphonates in

solid tumours: recommendations of an international expert

panel. Ann Oncol 2008;19:420–32.

Ibrahim A, Scher N, Williams G, Sridhara R, Li N, Chen G,

et al. Approval summary for Zoledronic acid for treatment of

multiple myeloma and cancer bone metastases. Clin Cancer

Res 2003;9(7):2394–9.

Major PP, Cook RJ, Chen BL, Zheng M. Survival-adjusted

multiple-event analysis for the evaluation of treatment effects

of Zoledronic Acid in patients with bone metastases from

solid tumors. Support Cancer Ther. 2005;2:234–40.

Gnant MF, Mlineritsch B, Luschin-Ebengreuth G, Grampp S,

Kaessmann H, Schmid M, et al. Zoledronic acid prevents

cancer treatment-induced bone loss in premenopausal women

receiving adjuvant endocrine therapy for hormone-responsive

breast cancer: a report from the Austrian Breast and

Colorectal Cancer Study Group. J Clin Oncol 2007;25:820–8.

Berry S, Waldron T, Winquist E, Lukka H. The use of

bisphosphonates in men with hormone-refractory prostate

cancer: a systematic review of randomized trials. Can J Urol

;13:3180–8.

Pazianas M, Miller P, Blumentals WA, Bernal M, Kothawala

P. A review of the literature on osteonecrosis of the jaw in

patients with osteoporosis treated with oral bisphosphonates:

prevalence, risk factors, and clinical characteristics. Clin Ther

;29:1548–58.

Saad F, Lipton A. Clinical benefits and considerations of

bisphosphonate treatment in metastatic bone disease. Semin

Oncol 2007;34(6 Suppl 4):S17–23.

Berenson J, Hirschberg R. Safety and convenience of a 15-

minute infusion of Zoledronic acid. Oncologist 2004;9:319–29.

Lacy MQ, Dispenzieri A, Gertz MA, Greipp PR, Gollbach

KL, Hayman SR, et al. Mayo clinic consensus statement for

the use of bisphosphonates in multiple myeloma. Mayo Clin

Proc 2006;81:1047–53.

Lipton A, Cook R, Saad F, Major P, Garnero P, Terpos E, et

al. Normalization of bone markers is associated with

improved survival in patients with bone metastases from

solid tumors and elevated bone resorption receiving

Zoledronic acid. Cancer 2008;113:193–201.

Smith MR. Markers of bone metabolism in prostate cancer.

Cancer Treat Rev 2006;32 (Suppl 1):23–6.

Hirsh V, Major PP, Lipton A, Cook RJ, Langer CJ, Smith MR,

et al. Zoledronic acid and survival in patients with metastatic

bone disease from lung cancer and elevated markers of

osteoclast activity. J Thorac Oncol 2008;3:228–36.


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