1/08 It is now completely accepted that osteonecrosis is an unwanted effect from bisphosphonates. Some have suggested that visiting a dentist and having one's teeth and gums treated PRIOR to treatment, may be one way to reduce risk. 10/06 Although we still occasionally see a paper suggesting this is an unproven connection, it seems most accept that bisphosphonates, like so many drugs, have complications. 5/31/04 The International Myeloma Foundation has issued a special advisory on this potential complication of bisphosphonate therapy. There is not yet any conclusive evidence that bisphosphates can cause this complication. Nevertheless, there have been enough cases reported to prompt the FDA to require that it be added to the Aredia and Zometa labeling. People taking bisphosphonates such as Aredia and Zometa should be aware of this issue and be particular attentive to any dental problems and catious about dental procedures. See http://www.myeloma.org/myeloma/myeloma_news.jsp?type=detail&id=1228 to read the advisory. You can find general information about bisphosphonate therapy at http://myeloma.org/myeloma/kb_index.jsp?type=detail&id=1165 8/03 HEADS UP on Possible Complications: A woman from SHARE (NYC-based self-help group for those w/breast or ovarian cancer) told Helen S. that she developed renal problems when she was on Aredia. Her oncologist, thinks it was caused by the interaction of Celebrex with Aredia. Apparently two other of his patients who were also taking both drugs also developed kidney problems. The woman said her kidney function is returning to normal but the doctor is worried about her developing kidney failure and does not want her to be on a bisphosphonate again. The dosage the woman was on was 800 mg a day. You might want to post this information online From Helen S. There is growing evidence that bisphosphonate drugs not only reduce bone pain and prevent tumor progression in cancer patients with bony metastases, but that they can reduce the size of metastatic tumors and possibly even prevent them. But these drugs are not yet indicated for prophylactic use outside of study protocols, even though off-label use is common. The latest data on bisphosphonates in cancer treatment were reviewed in presentations at the International Congress on Bone Metastases (ICBM), in Paris, France. "At the moment, all the evidence is in animal models and cell line systems, but, consistently, these have shown that most of the bisphosphonates have effects on cell proliferation in breast cancer and in myeloma," said Robert E. Coleman, MD, a consultant medical oncologist in the Department of Clinical Oncology, University of Sheffield. "The more potent agents also can induce apoptosis and affect adhesion molecules in various metastatic processes." He said these effects are seen at 10- to 100-micro-molar concentrations. These are higher than the doses indicated for treatment of osteoporosis, the original indication for bisphosphonates, but the higher drug levels are achievable close to the bone surface where metastatic destruction occurs. "We need to wait for the ongoing clinical studies to show whether the newest bisphosphonates really do cause apoptosis, and hopefully we will have clinical evidence of this in the next six to 12 months," Dr. Coleman said. Meanwhile, he said, bisphosphonates should only be used prophylactically in cancer patients in clinical trials, except, of course, in those who need these compounds for concomitant osteoporosis. "Osteoporosis is a very common co-existing condition with cancer," Dr. Coleman said. For example, older women with breast cancer and older men with prostate cancer would be at risk for osteoporosis, he said. "And younger women who have had chemotherapy would have early menopause and, therefore, similar concerns about skeletal health," he added. The osteoporosis dose of bisphosphonate tends to be lower than that used in cancer protocols, Dr. Coleman reiterated, but he added that the bisphosphonates have very mild toxicity profiles and there is little harm in giving higher doses for osteoporosis. "One would not be doing any harm with regard to the cancer, and the hope would be that one might be doing some good," he said. Ann's NOTE: This relatively non-toxic treatment can be given as a preventive measure. Show these articles to your doctor. Most oncologists are willing to use chemotherapy experimentally, why not these drugs? Bisphosphonates include Aredia (pamidronate) Zolodronate, clodronate (available as oral medication in Canada and Europe), also Fosomax. I have been interested in bisphosphantes since 1995. Thanks to Doctor's Guide for this important information. |
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