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Article: Bisphosphonates for advanced prostate cancer

TitleBisphosphonates for advanced prostate cancer
Authors
Issue Date2006
PublisherJohn Wiley & Sons Ltd. The Journal's web site is located at http://www.mrw.interscience.wiley.com/cochrane/cochrane_clsysrev_articles_fs.html
Citation
Cochrane Database Of Systematic Reviews, 2006 n. 4, p. CD006250 How to Cite?
AbstractBACKGROUND: Prostate cancer is the most common cancer in men in many western countries. It is characterized by its propensity for bone metastases which occur in more than 80% of patients with advanced disease. Patients are at risk of complications including pain, hypercalcaemia, bone fracture and spinal cord compression. Hormonal treatment is the mainstay of treatment for these patients but most of them will then become hormone refractory. Bisphosphonates act by inhibiting osteoclast activities and are a potential therapeutic option for metastatic prostate cancer. In addition, they have been shown to reduce pain in patients with bone metastases as a consequence of multiple myeloma. Early uncontrolled studies of bisphosphonates in metastatic prostate cancer patients have shown encouraging results. OBJECTIVES: The objective of this review was to determine the effectiveness of bisphosphonates in relieving pain in patients with bone metastases from prostate cancer. SEARCH STRATEGY: Studies were identified by electronic search of bibliographic databases including MEDLINE, EMBASE, CancerLit and the Cochrane Controlled Trials Register. Handsearching included Proceedings of American Society of Clinical Oncology and reference lists of all eligible trials identified. SELECTION CRITERIA: Randomised controlled studies comparing the effectiveness of bisphosphonates with placebo or open control for pain relief in patients with bone metastases from prostate cancer. DATA COLLECTION AND ANALYSIS: Data were extracted from eligible studies and included study design, participants, interventions and outcomes. Comparable data were pooled together for meta-analysis with intention-to-treat principle. Outcomes included pain response, analgesic consumption, skeletal events (including pathological fractures, spinal cord compression, bone radiotherapy, bone surgery), prostate cancer death, disease progression, radiological response, PSA response, adverse events, performance status, quality of life and comparisons between different routes, doses and types of bisphosphonates. MAIN RESULTS: One thousand nine hundred and fifty-five patients from ten studies were included in this review. The pain response rates were 27.9% and 21.1% for the treatment group and the control group, respectively, with an absolute risk difference of 6.8%.The OR for pain response was 1.54 (95% CI 0.97 to 2.44, P = 0.07), showing a trend of improved pain relief in the bisphosphonate group, although this was not statistically significant. The rates for skeletal events were 37.8% and 43.0% for the treatment group and the control group, respectively, with an absolute risk difference of 5.2%. The OR for skeletal events was 0.79 (95% CI 0.62 to 1.00, P = 0.05). A significant increase in nausea was observed in patients who received bisphosphonates compared to placebo. No increase in other adverse events was observed. There was no statistically significant difference between the bisphosphonate group and the control group in terms of prostate cancer death, disease progression, radiological response and PSA response. There are insufficient data to guide the choice of bisphosphonates or the dose and the route of administration . AUTHORS' CONCLUSIONS: Bisphosphonates should be considered for patients with metastatic prostate cancer for the treatment of refractory bone pain and prevention of skeletal events. More research is needed to guide the choice of bisphosphonates, optimal treatment schedule as well as cost-benefit comparisons. Combining results from different studies is difficult because different tools were used to assess pain, and also, bisphosphonates vary considerably in potency. This review highlights the need for standardisation and co-ordination among researchers in cancer pain studies.
Persistent Identifierhttp://hdl.handle.net/10722/178293
ISSN
2014 Impact Factor: 6.035
2015 SCImago Journal Rankings: 2.366
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorYuen, KKen_US
dc.contributor.authorShelley, Men_US
dc.contributor.authorSze, WMen_US
dc.contributor.authorWilt, Ten_US
dc.contributor.authorMason, MDen_US
dc.date.accessioned2012-12-19T09:45:05Z-
dc.date.available2012-12-19T09:45:05Z-
dc.date.issued2006en_US
dc.identifier.citationCochrane Database Of Systematic Reviews, 2006 n. 4, p. CD006250en_US
dc.identifier.issn1469-493Xen_US
dc.identifier.urihttp://hdl.handle.net/10722/178293-
dc.description.abstractBACKGROUND: Prostate cancer is the most common cancer in men in many western countries. It is characterized by its propensity for bone metastases which occur in more than 80% of patients with advanced disease. Patients are at risk of complications including pain, hypercalcaemia, bone fracture and spinal cord compression. Hormonal treatment is the mainstay of treatment for these patients but most of them will then become hormone refractory. Bisphosphonates act by inhibiting osteoclast activities and are a potential therapeutic option for metastatic prostate cancer. In addition, they have been shown to reduce pain in patients with bone metastases as a consequence of multiple myeloma. Early uncontrolled studies of bisphosphonates in metastatic prostate cancer patients have shown encouraging results. OBJECTIVES: The objective of this review was to determine the effectiveness of bisphosphonates in relieving pain in patients with bone metastases from prostate cancer. SEARCH STRATEGY: Studies were identified by electronic search of bibliographic databases including MEDLINE, EMBASE, CancerLit and the Cochrane Controlled Trials Register. Handsearching included Proceedings of American Society of Clinical Oncology and reference lists of all eligible trials identified. SELECTION CRITERIA: Randomised controlled studies comparing the effectiveness of bisphosphonates with placebo or open control for pain relief in patients with bone metastases from prostate cancer. DATA COLLECTION AND ANALYSIS: Data were extracted from eligible studies and included study design, participants, interventions and outcomes. Comparable data were pooled together for meta-analysis with intention-to-treat principle. Outcomes included pain response, analgesic consumption, skeletal events (including pathological fractures, spinal cord compression, bone radiotherapy, bone surgery), prostate cancer death, disease progression, radiological response, PSA response, adverse events, performance status, quality of life and comparisons between different routes, doses and types of bisphosphonates. MAIN RESULTS: One thousand nine hundred and fifty-five patients from ten studies were included in this review. The pain response rates were 27.9% and 21.1% for the treatment group and the control group, respectively, with an absolute risk difference of 6.8%.The OR for pain response was 1.54 (95% CI 0.97 to 2.44, P = 0.07), showing a trend of improved pain relief in the bisphosphonate group, although this was not statistically significant. The rates for skeletal events were 37.8% and 43.0% for the treatment group and the control group, respectively, with an absolute risk difference of 5.2%. The OR for skeletal events was 0.79 (95% CI 0.62 to 1.00, P = 0.05). A significant increase in nausea was observed in patients who received bisphosphonates compared to placebo. No increase in other adverse events was observed. There was no statistically significant difference between the bisphosphonate group and the control group in terms of prostate cancer death, disease progression, radiological response and PSA response. There are insufficient data to guide the choice of bisphosphonates or the dose and the route of administration . AUTHORS' CONCLUSIONS: Bisphosphonates should be considered for patients with metastatic prostate cancer for the treatment of refractory bone pain and prevention of skeletal events. More research is needed to guide the choice of bisphosphonates, optimal treatment schedule as well as cost-benefit comparisons. Combining results from different studies is difficult because different tools were used to assess pain, and also, bisphosphonates vary considerably in potency. This review highlights the need for standardisation and co-ordination among researchers in cancer pain studies.en_US
dc.languageengen_US
dc.publisherJohn Wiley & Sons Ltd. The Journal's web site is located at http://www.mrw.interscience.wiley.com/cochrane/cochrane_clsysrev_articles_fs.htmlen_US
dc.relation.ispartofCochrane database of systematic reviewsen_US
dc.subject.meshBone Density Conservation Agents - Therapeutic Useen_US
dc.subject.meshBone Neoplasms - Drug Therapy - Secondaryen_US
dc.subject.meshDiphosphonates - Therapeutic Useen_US
dc.subject.meshHumansen_US
dc.subject.meshMaleen_US
dc.subject.meshPain - Drug Therapy - Etiologyen_US
dc.subject.meshProstatic Neoplasmsen_US
dc.subject.meshRandomized Controlled Trials As Topicen_US
dc.titleBisphosphonates for advanced prostate canceren_US
dc.typeArticleen_US
dc.identifier.emailYuen, KK: fkhyuen@hku.hken_US
dc.identifier.authorityYuen, KK=rp00456en_US
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.doi10.1002/14651858.CD006250-
dc.identifier.pmid17054286-
dc.identifier.scopuseid_2-s2.0-34548145020en_US
dc.identifier.scopuseid_2-s2.0-39049180180-
dc.identifier.hkuros137828-
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-34548145020&selection=ref&src=s&origin=recordpage-
dc.identifier.issue4en_US
dc.identifier.spageCD006250en_US
dc.identifier.isiWOS:000241386000109-
dc.publisher.placeUnited Kingdomen_US
dc.identifier.scopusauthoridYuen, KK=8639606900en_US
dc.identifier.scopusauthoridShelley, M=7006987492en_US
dc.identifier.scopusauthoridSze, WM=7003795941en_US
dc.identifier.scopusauthoridWilt, T=7006004410en_US
dc.identifier.scopusauthoridMason, MD=7201987236en_US

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