ZOLEDRONIC ACID IN METASTATIC BONE DISEASE: AN AUDIT BASED DISCUSSION
AbstractBackground: Metastatic bone disease is a common problem in patients with advanced cancer causingsignificant morbidity and poor quality of life. Effective and less toxic treatments, like bisphophonates, canreduce morbidity in such cases. Objectives: The objectives of this study were to determine whetherZoledronic acid was administered in accordance with current recommendations for its prescribing and toproduce protocols for improved patient outcomes. Methods: The study was a retrospective audit of 39consecutive patients with metastatic bone disease secondary to solid tumours who were treated withZoledronic acid. The records were analysed to establish the administered dose of Zoledronic acid relativeto creatinine clearance. The standards for Zoledronic acid therapy were defined from best practiceguidelines. Results: The commonest diagnosis in patients receiving Zoledronic acid was carcinomaprostate 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%), andprevention of chemotherapy induced bone loss 1/39 (3%). The dose of Zoledronic acid was appropriate tothe 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. Thedose of Zoledronic acid was appropriate to serum creatinine clearance in a majority of patients. Poordocumentation of data pertaining to Zoledronic acid treatment is observed which can potentially lead tomajor errors in prescribing. We recommend using a standard form to document each episode of therapywith Zoledronic acid.Keywords: Zoledronic Acid, Metastatic Bone Disease, Audit
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
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
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
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
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.
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.