= Zometa zoledronic acid (a bisphosphonate) shows work best and even cost-effective means to botversterkende against bone loss in solid tumors. Article posted June 30, 2008
June 30, 2008: Source: 1: Pharmacoeconomics. 2008, 26 (3) :251-68.
Zoledronic acid: a pharmacoeconomic review of ITS use in the management of bone metastases.
Wolters Kluwer Health | Adis, Auckland, New Zealand. demail@adis.co.nz
Zoledronic acid (Zometa is a third-generation nitrogen-containing parenteral bisphosphonates Indicated for the treatment of bone metastases due to solid tumoren or multiple myeloma and for hypercalcaemia of malignancy (HCM). In patients with advanced breast or prostate cancer, zoledronic acid 4 mg Every 3-4 weeks for up to 15 months significantly Reduced the proportioning of Patients with> or = 1 skeletal-related event (SRE), Excluding HCM, compared with placebo. In patients with advanced breast cancer or multiple myeloma, the incidence of SREs was similar in patiënten Treated with zoledronic acid 4 mg or 90 mg acid pamidronic everytime 3-4 weeks for up to 25 months but, in breast cancer patients, zoledronic acid Reduced the risk of SREs, include HCM, by an Additional 20% compared with pamidronic acid.In Modelled cost-utility studies Comparing direct costs based on efficacy and resource-use data from thesis and / or Other trials, results have VARIED. Performed in the must recent study from the perspective of the UK NHS and Modelled on a 10 -year treatment period in women with advanced breast cancer, intravenous zoledronic acid and oral ibandronic acid Were dominant over no treatment. Intravenous zoledronic acid was the wine cost effective in terms of incremental costs per QALY gained, followed by oral ibandronic acid, intravenous pamidronic acid and intravenous ibandronic acid. Two Other Modelled analysis in patient with advanced breast cancer, Also Conducted from the perspective of the NHS, Evaluated the cost utility of three bisphosphonates therapies in patient receiving Hormonal therapy or intravenous chemotherapy. Analyses Were Modelled over 14.3 months ( ie expected survival) and Assumptions VARIED markedly from results in clinical breast cancer trials. Also, efficacy for zoledronic acid Assumptions Were not based on clinical trials with the drug. The results of analysis suggest That thesis oral ibandronic acid is more cost effective Than intravenous zoledronic acid and intravenous pamidronic acid in terms of incremental cost per QALY gained. In a global, 15-month Modelled cost-effectiveness analysis of Patients with advanced prostate cancer, Conducted from a third party perspective, the incremental cost per QALY gained for zoledronic acid versus no treatment was $ US159 200 (year 2000 value), Which is about 3-fold Greater Than comm only accepted thresholds for cost effectiveness.In Conclusion, a recent economic analysis suggests Modelled That intravenous zoledronic acid 4 mg is dominant relative to no treatment at the management of bone metastases in patient with advanced breast cancer. In contrast, in patients with advanced prostate cancer, the incremental cost per QALY gained for zoledronic acid 4 mg versus no treatment was predicted to be Higher Than comm only accepted thresholds. Compared with Other bisphosphonates in the setting of advanced breast cancer, intravenous zoledronic acid was more cost effective oral or intravenous Than ibandronic acid and intravenous pamidronic acid in one study, but less cost effective oral Than ibandronic acid in another. Further efficacy and economic data Comparing intravenous zoledronic acid with oral ibandronic acid are Needed. Meanwhile, zoledronic acid Appears To Be The Most cost effective intravenous bisphosphonates for the management of bone metastases in patient with advanced breast cancer and may possibly in patient with advanced solid tumoren or differential types.
PMID: 18282018 [PubMed - indexed for MEDLINE]
1: Oncologist. May 2008, 13 (5) :503-14. 
Integrated analysis of zoledronic acid for prevention of aromatase inhibitor-associated bone loss in postmenopausal women with early breast cancer receiving adjuvant letrozole.
Magee-Women's Hospital, Pittsburgh, Pennsylvania 15123, USA. brufskyam@upmc.edu
BACKGROUND: The interim (12-month) results of two similarly designed, ongoing studies (the Zometa-Femara Adjuvant Synergy Trials [Z-FAST and ZO-FAST]) suggest That zoledronic acid (4 mg intravenously everytime 6 months) When initiated with adjuvant letrozole increases bone mineral density (BMD) of the lumbar spine (LS) in postmenopausal women with early-stage breast cancer compared with Patients who receive zoledronic acid Only When Became Clinically significant bone loss or a Fragility fracture occurred. METHODS: An integrated analysis was Performed to maximize the value of the large pool of data from the two studies in answering Clinically relevant questions. The primary objectification was to compare the change in LS BMD at month 12. Secondary Objectives included compare (a) the change in total hip (TH) BMD, (b) changes in bone turnover marker Concentrations, (c) Recurrence time to disease, and (d) safety at month 12. FINDINGS: The integrated analysis included 1667 patiënten. At month 12, LS BMD was 5.2% higher in the upfront group now in the delayed group; TH BMD was 3.5% higher. N-telopeptide and bone-specific alkaline phosphatase Concentrations Decreased by 21.3% and 12.8% in the upfront group and Increased by 21.7% and 24.9% in the delayed group, respectively (p <.0001 for intergroup comparisons). Fewer Patients receiving upfront zoledronic acid Experienced Than Disease Recurrence patients in the delayed group patiënten-seven (0.84%) versus 17 patients (1.9%) (p = .0401). Were similar fracture rates. No. CONFIRMED osteonecrosis of the jaw were reported. CONCLUSIONS: The results of this analysis strictly then the statistical validity of the preliminary results of the Z-FAST and ZO-FAST studies, showing That upfront zoledronic acid Prevents Aromatase inhibitor-associated bone loss more effectively Than delayed-start zoledronic acid in postmenopausal women with early-stage breast cancer receiving letrozole. Additionally, disease Recurrence Appears to be lower with upfront zoledronic acid, but Further follow-up Needed to confirm thesis interim results.
PMID: 18515735 [PubMed - in process]
1: Cancer. 2008 May 5; 113 (1) :193-201. [Epub ahead of print] 
Normalization of bone markers is associated with improved survival in patient with bone metastases from solid tumors and elevated bone resorption receiving zoledronic acid.
Department of Hematology] Oncology, Milton S. Hershey Medical Center, Pennsylvania State University, Hershey, Pennsylvania.
BACKGROUND.: For Patient with bone metastases, high N-telopeptide of type I collagen (NTX) levels correlate with late Increased risks of skeletal-related events and death. However, the Relation Between NTX decreases and clinical benefits is Unclear. METHODS.: Correlations Between Normalization consistently NTX treatment and clinical outcome retrospectively Were Analyzed in 3 large, phase 3 trials. Urinary NTX Levels Were Measured at baseline and at Month 3 in patient with bone metastases from breast cancer (BC, n = 578), hormone-refractory prostate cancer (HRPC n = 472), or nonsmall-cell lung cancer and Other solid tumors (NSCLC / OST, n = 291) who Received zoledronic acid or control (pamidronate for BC, placebo for HRPC and NSCLC / OST) for up to 24 months. NTX levels Were characterized as normal (N, <64 nmol / mmol creatinine) or elevated (E,> / = 64 nmol / mmol creatinine). RESULTS.: After 3 months of zoledronic acid, N-group must patiënten Maintained normal levels, however, most E-group patiënten Their normalized NTX levels (BC, 81%; HRPC, 70% NSCLC / OST, 81%). In contrast, NTX levels normalized in 65% with pamidronate or BC, with 8% or placebo in HRPC, and in 17% of NSCLC / OST E-group patient. Normalized NTX correlated with improved overall survival versus persistently elevated NTX (significant for zoledronic acid-treated patients; trend for placebo-treated patients). More About, réductions rate from baseline NTX levels correlated with Regard less or benefits whethere Patients transitioned from E to N. CONCLUSIONS.: Zoledronic acid normalizes or maintainAspectRatio normal NTX levels in musts patiënten with bone metastases. Normalized NTX within-treatment or 3 months, versus persistently elevated NTX, was associated with Reduced Risk of Skeletal Complications and death. Cancer 2008. (C) 2008 American Cancer Society.
PMID: 18459173 [PubMed - as supp song by publisher]
1: J Clin Oncol. 2005 May 20, 1923 (15) :3314-1921. Epub 2005 in February 1928. 
- Comment in:
- J Clin Oncol. 2005 May 20, 1923 (15) :3299-301.
Reduces Skeletal Complications zoledronic acid significantly compared with placebo in Japanese women with bone metastases from breast cancer: a randomized, placebo-controlled trial.
Department of Surgery, Hyogo Medical Center for Adults, 13-70 Kitaojicho Akashi 673-0021, Japan. norio@tiger.interq.or.jp
PURPOSE: To Investigate the efficacy and safety of zoledronic acid for the treatment of bone metastases from breast cancer. PATIENT AND METHODS: Women with bone metastases (N = 228) Were Randomly Assigned to receive 4 mg zoledronic acid (n = 114) or placebo (n = 114) via 15-minute infusions everytime 4 weeks for 1 year. The primary efficacy end point was the skeletal-related event (SRE) rate ratio Between treatment groups. An SRE was defined as pathology fracture, spinal cord compression, and radiation or surgery to bone. Secondary endpoints included percentage of Patients with at least one SRE, time to first SRE, and Andersen-Gill multiple-event analysis. RESULTS: The SRE rate ratio at 1 year (Excluding HCM and adjusted for prior fracture) was 0.61 (Permutation test, P = .027), zoledronic acid Indicating That Reduced the rate of SREs by 39% compared with placebo. The percentage of Patients with at least one SRE (Excluding HCM) was significantly Reduced by 20% by zoledronic acid (29.8% v 49.6% for placebo, P = .003). Zoledronic acid significantly delayed time to first SRE (median not Reached v 364 days, Cox regression, P = .007) and the Reduced risk of SREs by 41% in multiple event analysis (risk ratio = 0.59, P = .019) compared with placebo. Zoledronic acid was well tolerated with a safety profile similar to placebo. No Patient Treated with zoledronic acid had grade 3 or 4 serum creatinine increasefontsize. CONCLUSION: Reduced Skeletal Complications zoledronic acid significantly compared with placebo across multiple endpoints in Japanese women with bone metastases from breast cancer.
PMID: 15738536 [PubMed - indexed for MEDLINE]
1: Cancer. 2008 May 5; 113 (1) :193-201. [Epub ahead of print]
Normalization of bone markers is associated with improved survival in patient with bone metastases from solid tumors and elevated bone resorption receiving zoledronic acid.
Department of Hematology] Oncology, Milton S. Hershey Medical Center, Pennsylvania State University, Hershey, Pennsylvania.
BACKGROUND.: For Patient with bone metastases, high N-telopeptide of type I collagen (NTX) levels correlate with late Increased risks of skeletal-related events and death. However, the Relation Between NTX decreases and clinical benefits is Unclear. METHODS.: Correlations Between Normalization consistently NTX treatment and clinical outcome retrospectively Were Analyzed in 3 large, phase 3 trials. Urinary NTX Levels Were Measured at baseline and at Month 3 in patient with bone metastases from breast cancer (BC, n = 578), hormone-refractory prostate cancer (HRPC n = 472), or nonsmall-cell lung cancer and Other solid tumors (NSCLC / OST, n = 291) who Received zoledronic acid or control (pamidronate for BC, placebo for HRPC and NSCLC / OST) for up to 24 months. NTX levels Were characterized as normal (N, <64 nmol / mmol creatinine) or elevated (E,> / = 64 nmol / mmol creatinine). RESULTS.: After 3 months of zoledronic acid, N-group must patiënten Maintained normal levels, however, most E-group patiënten Their normalized NTX levels (BC, 81%; HRPC, 70% NSCLC / OST, 81%). In contrast, NTX levels normalized in 65% with pamidronate or BC, with 8% or placebo in HRPC, and in 17% of NSCLC / OST E-group patient. Normalized NTX correlated with improved overall survival versus persistently elevated NTX (significant for zoledronic acid-treated patients; trend for placebo-treated patients). More About, réductions rate from baseline NTX levels correlated with Regard less or benefits whethere Patients transitioned from E to N. CONCLUSIONS.: Zoledronic acid normalizes or maintainAspectRatio normal NTX levels in musts patiënten with bone metastases. Normalized NTX within-treatment or 3 months, versus persistently elevated NTX, was associated with Reduced Risk of Skeletal Complications and death. Cancer 2008. (C) 2008 American Cancer Society.
PMID: 18459173 [PubMed - as supp song by publisher]
