Bisphosphonates in the treatment of patients with lung cancer and metastatic bone disease: a systematic review and meta-analysis.

Bisphosphonates in the treatment of patients with lung cancer and metastatic bone disease: a systematic review and meta-analysis.
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DOI:
10.1007/s00520-012-1563-z
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发表时间:
2012-11
影响因子:
3.1
通讯作者:
Suarez-Almazor, Maria E.
Suarez-Almazor, Maria E.
中科院分区:
医学2区
文献类型:
--
作者:
Lopez-Olivo, Maria A.;Shah, Nimit A.;Pratt, Greg;Risser, Jan M.;Symanski, Elaine;Suarez-Almazor, Maria E.

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Bisphosphonates are known to prevent skeletal-related events (SREs) in advanced breast cancer, prostate cancer and multiple myeloma. This systematic review assessed the efficacy of bisphosphonates in preventing SREs, controlling pain, and overall survival in patients with bone metastases from lung cancer. We searched MEDLINE, EMBASE, Web of Science, and the Cochrane Library databases through November 10, 2011, for controlled trials that included lung cancer patients with bone metastases treated with bisphosphonates. Two reviewers independently extracted data on pain control, survival, SREs and evaluated the quality of each study. Meta-analyses were performed when there were two or more trials with similar outcomes. Twelve trials, met our inclusion criteria, and included 1,767 patients. Studies were placebo-controlled or compared bisphosphonates with other modalities (chemotherapy, radiation therapy, or radioisotope therapy), or used different bisphosphonates as active controls. Randomized controlled trials did not report adequate descriptions of randomization procedures, allocation concealment, and blinding, resulting in low quality scores. Patients treated with zoledronic acid + chemotherapy had fewer SREs than those receiving chemotherapy alone (relative risk (RR) 0.81, 95% confidence interval (CI) 0.67-0.97). Pain control improved when a bisphosphonate was added to another treatment modality (chemotherapy or radiation; RR 1.18, 95%CI 1.0-1.4). Bisphosphonate therapy improved survival compared to controls, but the difference failed to reach statistical significance (mean of 72 days, 95%CI −8.9-152.9). Treatment with bisphosphonates reduced SREs, improved pain control and showed a trend to increased survival. Bisphosphonates should be used in the treatment of patients with lung cancer and bone metastases.
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