Evaluation of safety and analgesic consumption in patients with advanced cancer treated with zoledronic acid

Abstract

BackgroundThe aim of the study was evaluation of zoledronic acid with regard to safety, effect on analgesic consumption and impact on occurrence of skeletal related events in patients with bone lesions from solid tumors and multiple myeloma.MethodsWe conducted an observational, 12-month, phase IV and multi-center study. One hundred and twenty-five symptomatic (pain) bone-metastatic patients were included between 2007 and 2009: 92 prostate cancers, 28 multiple myelomas, 5 others. They were prescribed monthly infusions of zoledronic acid in accordance to each disease’s treatment guidelines. Analgesics consumption, pain and laboratory values were evaluated.ResultsZoledronic acid was prescribed concurrent to initial therapy for myeloma and only in late stage of prostate cancer. With treatment, percentage of patients on analgesics decreased in myeloma group (from 57% to 24%) and increased in prostate cancer group (from 70% to 88%). In patients with any analgesics, the use of opiates’ prescription dropped from 72.9% to 64%, percentages of non-steroidal analgesics and other mild analgesics increased slightly. Pain score (Visual Analog Scale, VAS) decreased non significantly (by 22%) in prostate cancer but significantly in myeloma (by 97%). Hypocalcaemia grade 3 or 4 was observed in 4% of patients. Deviations in creatinine remained stable throughout. A total of 31 skeletal related events were reported for 10 patients (8%).ConclusionsZoledronic acid was safe medication. Different response of pain was seen between prostate cancer and myeloma patients, which might be due to different stages of disease where it was prescribed according to present guidelines. Possibility of earlier start of treatment should be explored in prostate cancer.

Using negative pressure wound therapy on microskin autograft wounds

“…The biological film of VSD can separate the grafted wound from the outside [13,24]. Moreover, continuous negative pressure draining efficiently clears wound exudation in all directions and alters the environment for bacterial growth, leading to effectively preventing bacterial infection because these fluids act as media for bacteria growth and obstacles for capillary growth [21,25]. Above all, we referred that NPWT could lower the infection rate of the microskin transplanted wound in the first several days after skin autografts.…”

“…The visual analog scale (VAS) is widely used in measuring local pain. The patient was asked to indicate his/her perceived pain intensity (most commonly) along a 100-mm horizontal line, and this rating was then measured as the VAS score [20,21].…”

Severe resistant hypocalcemia in multiple myeloma after zoledronic acid administration: a case report

“…Bisphosphonates are generally well tolerated, although they are occasionally associated with adverse events namely hypocalcemia, nephrotoxicity, pancytopenia and osteonecrosis [ 5 - 7 ].…”

“…All bisphosphonates can cause hypocalcemia, regardless of their method of administration, although this is infrequently found to be a clinically symptomatic problem [ 7 , 8 ]. Of note, symptomatic hypocalcemia after ZA is rarely reported.…”

Hypocalcaemia in patients with prostate cancer treated with a bisphosphonate or denosumab: prevention supports treatment completion

“…A 12-month observational study of 125 patients with bone metastases (including 92 patients with prostate cancer) who were receiving zoledronic acid showed that hypocalcaemia of any grade occurred in 18.5% of the patients with prostate cancer. Of patients with any tumour type, hypocalcaemia of grade 3 or 4 occurred in 4% [ 31 ]. The higher incidence of hypocalcaemia encountered in real-world studies compared with clinical trials may reflect poor adherence to guidelines for calcium supplementation and monitoring of patients in clinical practice [ 12 ].…”