American Society of Clinical Oncology Clinical Practice Guidelines: The Role of Bisphosphonates in Multiple Myeloma

DOI Web Site 被引用文献15件
  • James R. Berenson
    From the American Society of Clinical Oncology, Health Services Research Department, Alexandria, VA.
  • Bruce E. Hillner
    From the American Society of Clinical Oncology, Health Services Research Department, Alexandria, VA.
  • Robert A. Kyle
    From the American Society of Clinical Oncology, Health Services Research Department, Alexandria, VA.
  • Ken Anderson
    From the American Society of Clinical Oncology, Health Services Research Department, Alexandria, VA.
  • Allan Lipton
    From the American Society of Clinical Oncology, Health Services Research Department, Alexandria, VA.
  • Gary C. Yee
    From the American Society of Clinical Oncology, Health Services Research Department, Alexandria, VA.
  • J. Sybil Biermann
    From the American Society of Clinical Oncology, Health Services Research Department, Alexandria, VA.

抄録

<jats:p> PURPOSE: To determine clinical practice guidelines for the use of bisphosphonates in the prevention and treatment of lytic bone disease in multiple myeloma and to determine their respective role relative to other conventional therapies for this condition. </jats:p><jats:p> METHODS: An expert multidisciplinary Panel reviewed pertinent information from the published literature through January 2002. Values for levels of evidence and grade of recommendation were assigned by expert reviewers and approved by the Panel. Expert consensus was used if there were insufficient published data. The Panel addressed which patients to treat and when to treat them in the course of their disease. Additionally, specific drug delivery issues, duration of therapy, initiation of treatment and management of treatment of lytic bone disease was reviewed and compared with other forms of therapy for lytic bone lesions. Finally, the Panel discussed patient and physician expectations associated with this therapy for bony metastases, as well as public policy implications related to the use of bisphosphonates. The guidelines underwent external review by selected physicians, by the Health Services Research Committee members, and by the ASCO Board of Directors. </jats:p><jats:p> RESULTS: The available evidence involving randomized controlled trials is modest but supports that oral clodronate, intravenous pamidronate, and intravenous zoledronic acid are superior to placebo in reducing skeletal complications. A reduction in vertebral fractures has consistently been seen across all studies. No agent has shown a definitive survival benefit. Intravenous zoledronic acid has recently been shown to be as effective as intravenous pamidronate. Because there are no direct comparisons between clodronate and pamidronate or zoledronic acid, the superiority of one agent cannot be definitively established. However, the panel recommends only intravenous pamidronate or zoledronic acid in light of the use of the time to first skeletal event as the primary end point and more complete assessment of bony complications in studies evaluating it. Additionally, clodronate is not available in the United States. The choice between pamidronate and zoledronic acid will depend on choosing between the higher drug cost of zoledronic acid, with its shorter, more convenient infusion time (15 minutes), versus the less expensive drug, pamidronate, with its longer infusion time (2 hours). </jats:p><jats:p> CONCLUSION: Bisphosphonates provide a meaningful supportive benefit to multiple myeloma patients with lytic bone disease. However, further research on bisphosphonates is warranted, including the following: (1) when to start and stop therapy, (2) how to integrate their use with other treatments for lytic bone disease, (3) how to evaluate their role in myeloma patients without lytic bone involvement, (4) how to distinguish between symptomatic and asymptomatic bony events, and (5) how to better determine their cost-benefit consequence. </jats:p>

収録刊行物

被引用文献 (15)*注記

もっと見る

キーワード

詳細情報 詳細情報について

問題の指摘

ページトップへ