RESUMO
PURPOSE: To evaluate the incidence of skeletal complications in patients with multiple myeloma, and metastatic breast, prostate, or lung cancers, when therapy with intravenous bisphosphonates is continued for longer than 21 months. METHODS: The primary outcome was the diagnosis of at least one skeletal-related event (SRE) after 21 months of therapy. The secondary outcome was the incidence of osteonecrosis of the jaws (ONJ). RESULTS: The primary outcome was 30%. The secondary outcome was 3%, while six patients (5%) were referred to a dentist for suspected ONJ. CONCLUSION: There appears to be a continued benefit when intravenous bisphosphonates are given for longer than 21 months.
Assuntos
Conservadores da Densidade Óssea/administração & dosagem , Neoplasias Ósseas/tratamento farmacológico , Difosfonatos/administração & dosagem , Fraturas Ósseas/prevenção & controle , Imidazóis/administração & dosagem , Compressão da Medula Espinal/prevenção & controle , Adulto , Idoso , Idoso de 80 Anos ou mais , Conservadores da Densidade Óssea/efeitos adversos , Neoplasias Ósseas/secundário , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/patologia , Difosfonatos/efeitos adversos , Esquema de Medicação , Feminino , Fraturas Ósseas/etiologia , Humanos , Imidazóis/efeitos adversos , Doenças Maxilomandibulares/induzido quimicamente , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/tratamento farmacológico , Mieloma Múltiplo/patologia , Osteonecrose/induzido quimicamente , Pamidronato , Neoplasias da Próstata/tratamento farmacológico , Neoplasias da Próstata/patologia , Estudos Retrospectivos , Compressão da Medula Espinal/etiologia , Fatores de Tempo , Resultado do Tratamento , Ácido ZoledrônicoRESUMO
The 5-hydroxytryptamine type 3 (5-HT3) receptor antagonists have become the cornerstone for preventing and treating chemotherapy-induced nausea and vomiting. Four 5-HT3 antagonists are commercially available in the United States, and numerous reports have been published comparing 2 or more agents. The studies ranged from randomized, double-blinded to open-label or retrospective trials; included chemotherapy-naïve and -non-naïve patients; and covered a range of doses and routes of administration with and without concomitant steroids, for preventing and treating nausea and vomiting after highly and moderately high emetogenic chemotherapy. With few exceptions, the studies uniformly show an equivalent efficacy rate and side effect profile among the various agents at equivalent doses. This article reviews the pharmacology of the class for insight into minor differences among the agents that could possibly influence drug selection for certain patients, and considers data on the absorption, half-life, metabolism, and receptor activity. Clinical trials support the claim of various guidelines that the 5-HT3 receptor antagonists are therapeutically similar in safety and efficacy, particularly because the current best practice for preventing nausea and vomiting after highly and moderately high emetogenic chemotherapy is a combination of a 5-HT3 antagonist, steroids, and aprepitant.