12月2日，Cancer上刊登了一則研究論文"Retrospective analysis of antitumor effects of zoledronic acid in breast cancer patients with bone-only metastases",，該論文的主要研究人員認(rèn)為唑來(lái)膦酸對(duì)于轉(zhuǎn)移性乳腺癌無(wú)抗腫瘤作用,。
通過(guò)對(duì)只有骨轉(zhuǎn)移的乳腺癌婦女服用唑來(lái)膦酸用以降低骨骼并發(fā)癥的進(jìn)一步研究發(fā)現(xiàn),，治療既沒(méi)有延長(zhǎng)無(wú)進(jìn)展生存期，也沒(méi)有延長(zhǎng)總體生存期。Naoto T. Ueno博士說(shuō)到，對(duì)于只有骨轉(zhuǎn)移的乳腺癌患者,，我們無(wú)法證明唑來(lái)膦酸的抗腫瘤作用。
研究者注意到,，臨床前研究表明雙磷酸鹽類有直接和間接的抗腫瘤作用,。他們希望只有骨轉(zhuǎn)移的乳腺癌患者，一般具有相對(duì)較長(zhǎng)的生存期,，添加唑來(lái)膦酸或帕米膦酸到標(biāo)準(zhǔn)治療方案中后,，能夠得到更好的生存期。
他們確認(rèn)了10年中在MD Anderson看病的314名該類病人,，當(dāng)確認(rèn)骨病時(shí),，172名患者接受了唑來(lái)膦酸，77名接受了帕米膦酸,，65名沒(méi)有接受任何雙磷酸鹽,。
單因素分析中，未使用雙磷酸鹽的無(wú)進(jìn)展生存期優(yōu)于帕米膦酸（HR,，0.57,；p=0.002）,。未使用雙磷酸鹽和唑來(lái)膦酸間無(wú)統(tǒng)計(jì)學(xué)差異（HR,，0.72；p=0.058）,，調(diào)整了一些諸如絕經(jīng)狀態(tài)和骨轉(zhuǎn)移數(shù)量的因素后,，多因素分析顯示二者仍沒(méi)有統(tǒng)計(jì)學(xué)差異（HR，0.80,；p=0.235）,。總生存期也同樣如此,，HR為1.34（p=0.192）,。
目前，使用唑來(lái)膦酸治療骨轉(zhuǎn)移是金標(biāo)準(zhǔn),，因?yàn)榭梢燥@著降低或預(yù)防骨骼相關(guān)事件,，但是，它不能延長(zhǎng)生存和顯示任何抗腫瘤作用使得爭(zhēng)議仍在,。病人和醫(yī)生都應(yīng)該對(duì)雙磷酸鹽治療的潛在益處有更加清楚的認(rèn)識(shí),。（生物谷Bioon.com）
doi:10.1002/cncr.26512
PMC:
PMID:
Retrospective analysis of antitumor effects of zoledronic acid in breast cancer patients with bone-only metastases.
Niikura N, Liu J, Hayashi N, Palla SL, Tokuda Y, Hortobagyi GN, Ueno NT, Theriault RL.
BACKGROUND:
Bisphosphonates have been used successfully in the treatment of hypercalcemia and to reduce skeletal complications of bone metastasis, but have not been shown to prevent bone metastasis or to prolong survival time in metastatic breast cancer patients. The aim of this study was to determine whether the progression-free survival (PFS) and overall survival (OS) of patients with bone-only breast cancer metastasis differed based on whether patients received zoledronic acid, pamidronate, or no bisphosphonate upon diagnosis of their metastases.
PATIENTS AND METHODS:
We retrospectively identified 314 patients diagnosed with bone-only metastasis at the time of initial staging or who developed bone metastasis as the first recurrence site during follow-up from January 1, 1997 to December 31, 2008, at The MD Anderson Cancer Center. Univariate and multivariate Cox hazards models were used to assess the effects of each treatment on PFS and OS.
RESULTS:
Patients who had more than 1 bone metastasis and Eastern Cooperative Oncology Group (ECOG) performance status of 2 and 3 were more likely to receive zoledronic acid in this analysis. Compared with no bisphosphonate use, the use of zoledronic acid was not significantly associated with longer PFS (hazard ratio [HR] = 0.72, P = .058 in univariate analysis, and HR = 0.80, P = .235 in multivariate analysis) nor with longer OS (HR = 1.04, P = .863 in univariate analysis and HR = 1.34, P = .192 in multivariate analysis).
CONCLUSION:
Our study demonstrates that for patients with bone-only metastases, zoledronic acid did not prolong PFS or OS. In patients with bone-only metastasis, we could not demonstrate antitumor effects of zoledronic acid.
