Zoledronic acid may have antimetastatic effects in breast cancer

January 01, 0001

Zoledronic acid may have antimetastatic effects in breast cancer

Treatment with bisphosphonates decreases bone loss and can increase disease-free survival in patients with breast cancer. The aim of this study by researchers from the US was to assess the effect of zoledronic acid on clearance of disseminated tumour cells (DTCs) from the bone marrow in women undergoing neoadjuvant chemotherapy for breast cancer. Eligible patients had clinical stage II—III newly diagnosed breast cancer and normal cardiac, renal, and liver function. 120 women were randomly assigned, using allocation concealment, to receive 4 mg zoledronic acid intravenously every 3 weeks (n=60), or no zoledronic acid (n=60), for 1 year concomitant with four cycles of neoadjuvant epirubicin (75 mg/m2) plus docetaxel (75 mg/m2) and two cycles of adjuvant epirubicin plus docetaxel. At 3 months, 109 bone-marrow samples were available for analysis.

At baseline, DTCs were detected in 26 of 60 patients in the zoledronic acid group and 28 of 58 patients in the control group. At 3 months, 17 of 56 patients receiving zoledronic acid versus 25 of 53 patients who did not receive zoledronic acid had detectable DTCs (significant). The most common grade 3—4 toxicities were infection (five of 60 patients in the zoledronic acid group and six of 59 in the control group) and thrombosis (five of 60 in the zoledronic acid and two of 59 in the control group). There was one documented case of osteonecrosis in the zoledronic acid group.

The researchers concluded: "Zoledronic acid administered with chemotherapy resulted in a decreased proportion of patients with DTCs detected in the bone marrow at the time of surgery. Our study supports the hypothesis that the antimetastatic effects of zoledronic acid may be through effects on DTCs."

Combining these therapies is an interesting concept. Disease-free survival was not part of this study and is extrapolated from other studies.

For the full abstract, click here.

The Lancet Oncology l 11(5):421-428, May 2010
© Elsevier Ltd 2010
Effect of zoledronic acid on disseminated tumour cells in women with locally advanced breast cancer: an open label, randomised, phase 2 trial. Rebecca Aft, Michael Naughton, Kathryn Trinkaus, Mark Watson et al. Correspondence to Dr Rebecca Aft: aftr@wustl.edu

Category: X. Female Genital System, Breast. Keywords: zoledronic acid, disseminated tumour cells, breast cancer, locally advanced, women, open label randomised, phase 2 trial, journal watch.
Synopsis edited by Dr Stephen Wilkinson, Melbourne, Australia. Posted on Global Family Doctor 21 May 2010

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