ANAHEIM, CaliforniaIn hormone-refractory prostate cancer patients,
bisphosphonates can relieve painful skeletal metastases, according to a study
presented at the American Urological Association annual meeting (abstract 691).
Achim Elert, MD, of Phillips University, Marburg, Germany, reported the
results of an open-label nonrandomized study of 105 patients with painful
osseous metastases who received clodronate (n = 85) or ibandronate (n = 20).
The mean survival of the patients was 12 weeks (range, 6 to 22 weeks).
Clodronate was started with an intravenous phase for 8 days at a dose of 300
mg/d followed by an oral maintenance phase at 1,600 mg/d. Ibandronate was given
in an intravenous dose of 6 mg monthly. Pain reduction was documented by the
use of a 10-point visual analog scale, and consumption of analgesics was
documented in a diary.
Palliative responses were seen in 75% of patients receiving clodronate (64
of 85) and in 90% of patients receiving ibandronate (18 of 20). This was
demonstrated by a significant reduction in pain scores, from 7.9 to 2.5 in the
clodronate group and from 7.3 to 2.1 in the ibandronate group (P < .001).
A number of patients were completely pain free, including 19 of 64
responding clodronate-treated patients (29.7%) and 10 of 18 ibandronate
responders (55.5%). Furthermore, 45 patients in the clodronate group and 8 in
the ibandronate group had significantly decreased consumption of daily
analgesics. Maximum pain reduction was achieved in 12 days with clodronate and
6.5 days with ibandronate, Dr. Elert said.
In both groups, improvement in bone pain was paralleled by an improvement in
Karnofsky index, from 45% to 70% at the end of the treatment period, mainly due
to improved mobility. No patient suffered a pathologic fracture during
Clodronate produced more gastrointestinal side effects: 17.7% vs none with