The risk of renal impairment in hormone‐refractory prostate cancer patients with bone metastases treated with zoledronic acid

Abstract

BACKGROUNDBisphosphonates have been used to treat bone metastases in hormone‐refractory prostate cancer (HRPC), but certain agents have been associated with renal toxicity. For this observational study, the authors assessed the risk of renal impairment in patients with HRPC who received zoledronic acid from December 1999 to April 2005.METHODSA comprehensive medical records review was performed in a major tertiary oncology center (n = 122 patients). The primary outcome of renal impairment was defined as an increase ≥0.5 mg/dL or ≥1.0 mg/dL over baseline creatinine value if the baseline value was <1.4 mg/dL or ≥1.4 mg/dL, respectively. A risk factor analysis was conducted using the Andersen‐Gill extension to the Cox proportional hazards model.RESULTSRenal impairment was observed in 23.8% of patients. The risk of renal impairment increased with an extended duration of zoledronic acid therapy (<6 months, 11.1%; ≥24 months, 26.3%) and previous pamidronate treatment (45.5% vs 19.0% for patients with no prior pamidronate). A significantly greater risk of renal impairment was associated with increasing age at zoledronic acid initiation, prior pamidronate use, and a history of renal disease, hypertension, or smoking (P ≤ 0.05).CONCLUSIONSIn an outpatient clinic setting, the risk of renal impairment among patients with HRPC who received zoledronic acid was greater than the risk reported previously in clinical trials. Cancer 2007 © 2007 American Cancer Society.

Is there a role for ibandronate in the treatment of prostate cancer patients with bony metastases?

“…The placebo-controlled study conducted by Saad et al [12] shows zoledronic acid to be well tolerated and safe for use in prostate cancer patients, while the studies conducted by Polascik et al [49] and Oh et al [50] would appear to contradict this. The latter two studies, however, were not placebo-controlled.…”

“…A retrospective, observational analysis assessing the risk of renal impairment in 122 [50] patients with HRPC has also been reported. Renal impairment was assessed using the same parameters as those of Polascik et al 2005 [49].…”

Bone-targeted Novel Cytotoxic Polybisphosphonate Conjugate in Castration-resistant Prostate Cancer: A Multicenter Phase 1 Study

“…There are several risk factors for CRPC patients predisposing for renal deterioration, e.g. previous bisphosphonate use, use of NSAID (non-steroidal anti-inflammatory drugs) and advanced cancer disease (18)(19)(20). Androgen deprivation therapy (ADT), leads to metabolic changes including dyslipidemia and hyperglycemia and together with castrate levels of testosterone, the metabolic changes have secondary negative effects on kidney function, which ultimately might result in acute renal failure (21).…”

Risk of renal failure in cancer patients with bone metastasis treated with renally adjusted zoledronic acid

“…A review of the literature reveals an incidence of renal failure anywhere from 9% to 24% [1][2][3][7][8][9]. When the incidence of renal failure is evaluated based on a 25% decline in creatinine clearance (CrCl), it can reach up to 42-54% [7,8,10,11].…”