Safety of long-term administration of bisphosphonates in elderly cancer patients.
BACKGROUND
To evaluate the effectiveness and tolerability of the long-term treatment bone metastases with pamidronate in older patients.


METHODS
Twenty-two ambulatory patients aged 70 or older were included in the study. The median age was 73 (range 70-77). Ten patients (46%) were affected by breast carcinoma, 7 (32%) by prostate carcinoma and 5 (22%) by multiple myeloma. Nine (40%) patients presented co-morbidity. All of the patients presented at least one metastatic lytic bone lesion measuring 1 cm or more in diameter; the median lesion number was 2 (range 1-4). Hormonal therapy or chemotherapy regimen, were allowed as clinically required. Patients were treated with a fixed dose of sodium pamidronate, 90 mg in 3 h infusion every 4 weeks.


RESULTS
Partial response was shown in 6 (28%) patients, stable disease in 11 (50%), and progression (PD) in 5 (22%). 2 out of 5 patients with PD presented skeletal-related events (SREs) such as bone fracture. The median treatment duration was 19 months. The treatment was well tolerated; in 5 patients (23%) a GI fever was observed, in 3 patients (18%) G1 nausea, and in 3 patients (14) G1 diarrhea. Two cases (9%) of acute renal insufficiency (creatinine 1.7 and 1.6 mg/dl), and 3 cases (14%) of hypocalcemia (7.6, 7.5 and 7.8 mg/dl) were also registered. The renal dysfunction was reversible and without consequence.


CONCLUSIONS
Our experience suggests that the bisphosphonates long-term administration is useful and did not cause significant side effects in elderly subjects. Low-grade pyrexia, nausea/vomiting, acute/reversible renal dysfunction and hypo-calcemia were the most frequent side effects reported. However, they were of low grade and in most cases, did not require dose modifications and/or hospitalization.
Tralongo
Paolo
P
Medical Oncology, G Di Maria Hospital, Avola, Italy. tralongo.paolo@virgilio.it
Repetto
Lazzaro
L
Di Mari
Anna
A
Mauceri
Gaetano
G
Bollina
Roberto
R
Ferrau'
Francesco
F
Conti
Gianfranco
G
D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D001859:Bone Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000556:secondary*; D001943:Breast Neoplasms / Q000473:pathology; D004164:Diphosphonates / Q000008:administration & dosage* / Q000009:adverse effects*; D004334:Drug Administration Schedule; D005260:Female; D050723:Fractures, Bone / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D006996:Hypocalcemia / Q000139:chemically induced; D008297:Male; D009101:Multiple Myeloma / Q000473:pathology; D000077268:Pamidronate; D011471:Prostatic Neoplasms / Q000473:pathology; D051437:Renal Insufficiency / Q000139:chemically induced; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D004164:Diphosphonates; D000077268:Pamidronate