Sunday, November 13, 2005

Bisphosphonates for bone mets in prostate cancer

The current J of Clinical Oncology is devoted to prostate cancer, & along those lines has a review on bisphosphonates for the prevention and treatment of bone metastases in prostate cancer.  It opens with a succinct summary of the pathophysiology of bony mets in prostate cancer, as well as the pharmacodynamics of bisphosphonates.  Next, it critically summarizes the data for bisphosphonates in prostate cancer, which is not much:  the only drug/situation that has demonstrated benefit is zoledronic acid for the treatment of asymptomatic mets in androgen-independent prostate cancer.  It showed a modest reduction in skeletal events (pathologic fracture, spinal cord compression, surgery or radiation therapy to bone, or change in antineoplastic treatment to treat bone pain) with a number needed to treat of ~10 to prevent one complication for 15 months of treatment.  I'm not suggesting a NNT of 10 is high, especially given the potentially devastating complications--cord compression, etc.--it's just that I was surprised by how little evidence there was. 
The other article I'll note from this issue is a review of therapy for advanced & refractory prostate cancer.  I'll give kudos to the authors for noting that palliation, pain, and supportive therapy are of primary importance in this setting & talking about that first thing in the article, before talking about chemo, etc.  It seems usually in review articles of this sort, supportive care is relegated to a paragraph at the end, if it all.  Newer chemotherapeutic agents and other treatments are briefly reviewed in the rest of the article.

Changes:  I am excited to announce that in the next week or so I'll be joined by a co-blogger on Pallimed!  More info to come....

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