12月2日，Cancer上刊登了一则研究论文"Retrospective analysis of antitumor effects of zoledronic acid in breast cancer patients with bone-only metastases"，该论文的主要研究人员认为唑来膦酸对于转移性乳腺癌无抗肿瘤作用。
通过对只有骨转移的乳腺癌妇女服用唑来膦酸用以降低骨骼并发症的进一步研究发现，治疗既没有延长无进展生存期，也没有延长总体生存期。Naoto T. Ueno博士说到，对于只有骨转移的乳腺癌患者，我们无法证明唑来膦酸的抗肿瘤作用。
研究者注意到，临床前研究表明双磷酸盐类有直接和间接的抗肿瘤作用。他们希望只有骨转移的乳腺癌患者，一般具有相对较长的生存期，添加唑来膦酸或帕米膦酸到标准治疗方案中后，能够得到更好的生存期。
他们确认了10年中在MD Anderson看病的314名该类病人，当确认骨病时，172名患者接受了唑来膦酸，77名接受了帕米膦酸，65名没有接受任何双磷酸盐。
单因素分析中，未使用双磷酸盐的无进展生存期优于帕米膦酸（HR，0.57；p=0.002）。未使用双磷酸盐和唑来膦酸间无统计学差异（HR，0.72；p=0.058），调整了一些诸如绝经状态和骨转移数量的因素后，多因素分析显示二者仍没有统计学差异（HR，0.80；p=0.235）。总生存期也同样如此，HR为1.34（p=0.192）。
目前，使用唑来膦酸治疗骨转移是金标准，因为可以显著降低或预防骨骼相关事件，但是，它不能延长生存和显示任何抗肿瘤作用使得争议仍在。病人和医生都应该对双磷酸盐治疗的潜在益处有更加清楚的认识。（生物谷Bioon.com）
doi:10.1002/cncr.26512
PMC:
PMID:
Retrospective analysis of antitumor effects of zoledronic acid in breast cancer patients with bone-only metastases.
Niikura N, Liu J, Hayashi N, Palla SL, Tokuda Y, Hortobagyi GN, Ueno NT, Theriault RL.
BACKGROUND:
Bisphosphonates have been used successfully in the treatment of hypercalcemia and to reduce skeletal complications of bone metastasis, but have not been shown to prevent bone metastasis or to prolong survival time in metastatic breast cancer patients. The aim of this study was to determine whether the progression-free survival (PFS) and overall survival (OS) of patients with bone-only breast cancer metastasis differed based on whether patients received zoledronic acid, pamidronate, or no bisphosphonate upon diagnosis of their metastases.
PATIENTS AND METHODS:
We retrospectively identified 314 patients diagnosed with bone-only metastasis at the time of initial staging or who developed bone metastasis as the first recurrence site during follow-up from January 1, 1997 to December 31, 2008, at The MD Anderson Cancer Center. Univariate and multivariate Cox hazards models were used to assess the effects of each treatment on PFS and OS.
RESULTS:
Patients who had more than 1 bone metastasis and Eastern Cooperative Oncology Group (ECOG) performance status of 2 and 3 were more likely to receive zoledronic acid in this analysis. Compared with no bisphosphonate use, the use of zoledronic acid was not significantly associated with longer PFS (hazard ratio [HR] = 0.72, P = .058 in univariate analysis, and HR = 0.80, P = .235 in multivariate analysis) nor with longer OS (HR = 1.04, P = .863 in univariate analysis and HR = 1.34, P = .192 in multivariate analysis).
CONCLUSION:
Our study demonstrates that for patients with bone-only metastases, zoledronic acid did not prolong PFS or OS. In patients with bone-only metastasis, we could not demonstrate antitumor effects of zoledronic acid.
