title: Adjuvant therapy with zoledronic acid in patients with breast cancer: a systematic review and meta-analysis.
abstract: BACKGROUND
  The purpose of the study was to estimate the impact on survival and fracture rates of the use of zoledronic acid versus no use (or delayed use) in the adjuvant treatment of patients with early-stage (stages I-III) breast cancer.
  
  
  METHODS
  We performed a systematic review and meta-analysis of randomized clinical trials. Trials were located through PubMed, ISI, Cochrane Library, and major cancer scientific meeting searches. All trials that randomized patients with primary breast cancer to undergo adjuvant treatment with zoledronic acid versus nonuse, placebo, or delayed use of zoledronic acid as treatment to individuals who develop osteoporosis were considered eligible. Standard meta-analytic procedures were used to analyze the study outcomes.
  
  
  RESULTS
  Fifteen studies were considered eligible and were further analyzed. The use of zoledronic acid resulted in a statistically significant better overall survival outcome (five studies, 6,414 patients; hazard ratio [HR], 0.81; 95% confidence interval [CI], 0.70-0.94). No significant differences were found for the disease-free survival outcome (seven studies, 7,541 patients; HR, 0.86; 95% CI, 0.70-1.06) or incidence of bone metastases (seven studies, 7,543 patients; odds ratio [OR], 0.94; 95% CI, 0.64-1.37). Treatment with zoledronic acid led to a significantly lower overall fracture rate (OR, 0.78; 95% CI, 0.63-0.96). Finally, the rate of osteonecrosis of the jaw was 0.52%.
  
  
  CONCLUSIONS
  Zoledronic acid as adjuvant therapy in breast cancer patients appears to not only reduce the fracture risk but also offer a survival benefit over placebo or no treatment.
authors: Department of Oncology, General Hospital of Eskilstuna, Eskilstuna, Sweden. valachis@hotmail.com
authors: Antonis
authors: A
authors: Valachis
authors: Nikolaos P
authors: NP
authors: Polyzos
authors: Robert E
authors: RE
authors: Coleman
authors: Michael
authors: M
authors: Gnant
authors: Holger
authors: H
authors: Eidtmann
authors: Adam M
authors: AM
authors: Brufsky
authors: Rebecca
authors: R
authors: Aft
authors: Amye J
authors: AJ
authors: Tevaarwerk
authors: Karen
authors: K
authors: Swenson
authors: Pehr
authors: P
authors: Lind
authors: Davide
authors: D
authors: Mauri
mesh_terms: D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology; D017024:Chemotherapy, Adjuvant; D004164:Diphosphonates / Q000008:administration & dosage* / Q000009:adverse effects; D018572:Disease-Free Survival; D005260:Female; D050723:Fractures, Bone / Q000150:complications / Q000188:drug therapy / Q000473:pathology; D006801:Humans; D007093:Imidazoles / Q000008:administration & dosage* / Q000009:adverse effects; D009367:Neoplasm Staging; D010024:Osteoporosis / Q000150:complications / Q000188:drug therapy / Q000473:pathology; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D000077211:Zoledronic Acid
chemical_list: D004164:Diphosphonates; D007093:Imidazoles; D000077211:Zoledronic Acid
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