Clinical research over the last decade has confirmed the helpful role of
bisphosphonates in the management of patients with bone
metastases secondary to
breast cancer and other
malignancies. This role is also expanding in myeloma and in the management of
osteoporosis. Current clinical research in oncology is focusing on their potential for the prevention of skeletal complications of malignant disease and the development of bone
metastases while basic researchers are developing compounds of higher potency and, perhaps, higher therapeutic efficacy. One of the earliest agents to be investigated,
etidronate, is effective in the management of malignant
hypercalcemia and, when used orally and intermittently, results in reduced bone loss in
osteoporosis. However, it does not appear to reduce
pain in patients with malignant disease.
Clodronate has been shown to be an effective agent in the management of
hypercalcemia and can be used as a single intravenous
infection for this purpose.
Clodronate is also effective in some patients in reducing bone
pain and improving mobility. When used orally, it can, as can
pamidronate, reduce the skeletal complications of
breast cancer such as
hypercalcemia,
bone fractures and bone
pain. It may have fewer gastrointestinal side effects than oral
pamidronate. There is emerging evidence that
bisphosphonates may delay or prevent the clinical appearance of bone
metastases as well as reduce other skeletal complications. Trials of adjuvant
bisphosphonates such as
clodronate and
pamidronate in operable
breast cancer are currently under way in Europe and North America.