The Use of Bisphosphonates in Elderly Cancer Patients

Abstract

LEARNING OBJECTIVESAfter completing this course, the reader will be able to:1. Discuss the role of bisphosphonate therapy in the management of metastatic bone disease.2. Describe the differences between individual bisphosphonates with regard to safety and route of administration.3. List the reasons for including elderly patients in clinical trials of bisphosphonates for the management of metastatic bone disease.Access and take the CME test online and receive 1 AMA PRA Category 1 Credit ™ at CME.TheOncologist.com CME CME ABSTRACTAs life expectancy increases throughout the 21st century, the size of the elderly population will also expand. This will have a marked effect on the number of patients with cancer who are classified as elderly. Despite this, the design of most clinical studies of cancer therapies excludes those patients who are >70 years of age.Bisphosphonates are an example of a cancer therapy that has not been examined in randomized clinical trials of elderly patients. These agents are used for the prevention of skeletal complications and the relief of bone pain in patients with bone metastases. When deciding which bisphosphonate to prescribe to an elderly patient, each drug should be considered on its individual merits. Examples of areas of concern with bisphosphonates in elderly patients include their relative renal safety profiles and propensity for osteonecrosis of the jaw. Another consideration when choosing the most appropriate formulation is the preferred method of administration (oral or i.v.), which may affect patient compliance with therapy.As the use of bisphosphonates increases, the need for data on their use in elderly patients also becomes greater. Clinical trials of bisphosphonates in this patient population are currently under way, and their results are keenly awaited. The Oncologist 2007;12:62-71

Management of pain in elderly patients receiving infusion of zoledronic acid for bone metastasis: a single-institution report

“…As underlined by Gridelli [5] in a recent review, without these data, it is not possible to predict the exact effects of bisphosphonates in this population. Bisphosphonate safety profiles are also relevant; side effects such as renal toxicity and ONJ must be considered.…”

Vejez y cáncer de mama, el desafío del siglo 21

“…Muchos pacientes AM tienen un deterioro de la función renal por lo que tienen un riesgo mayor de nefrotoxicidad asociada al uso de bifosfonatos endovenosos. Los bifosfonatos orales, al igual que el denosumab de uso subcutáneo, no son asociados con efectos adversos en la función renal, y más aun no necesitan visitas al hospital, lo que es especialmente importante en pacientes con difi cultades en transporte y movilización [56][57][58][59] . El riesgo de osteonecrosis de mandíbula también podría estar aumentado en pacientes AM, ya que las infecciones y procedimientos dentales; más frecuentes en este grupo; son un factor de riesgo para la aparición de esta complicación.…”

Bisfosfonatos e osteonecrose maxilar: uma revisão narrativa da literatura

“…Esses medicamentos podem ser divididos em dois subgrupos dependendo da presença ou não de nitrogênio, e são denominados de aminados e não aminados (Gridelli, 2007).…”