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Bisphosphonates in the treatment of patients with lung cancer and metastatic bone disease: a systematic review and meta-analysis

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Abstract

Purpose

Bisphosphonates are known to prevent skeletal-related events (SREs) in advanced breast cancer, prostate cancer, and multiple myeloma. This systematic review assessed the efficacy of bisphosphonates in preventing SREs, controlling pain, and overall survival in patients with bone metastases from lung cancer.

Methods

We searched MEDLINE, EMBASE, Web of Science, and the Cochrane Library databases through November 10, 2011 for controlled trials that included lung cancer patients with bone metastases treated with bisphosphonates. Two reviewers independently extracted data on pain control, survival, and SREs and evaluated the quality of each study. Meta-analyses were performed when there were two or more trials with similar outcomes.

Results

Twelve trials met our inclusion criteria and included 1,767 patients. Studies were placebo-controlled, or had compared bisphosphonates with other modalities (chemotherapy, radiation therapy, or radioisotope therapy), or had used different bisphosphonates as active controls. Randomized controlled trials did not report adequate descriptions of randomization procedures, allocation concealment, and blinding, resulting in low-quality scores. Patients treated with zoledronic acid + chemotherapy had fewer SREs than those receiving chemotherapy alone (relative risk (RR) 0.81, 95 % confidence interval (CI) 0.67–0.97). Pain control improved when a bisphosphonate was added to another treatment modality (chemotherapy or radiation; RR 1.18, 95 %CI 1.0–1.4). Bisphosphonate therapy improved survival compared to controls, but the difference failed to reach statistical significance (mean of 72 days, 95 %CI −8.9 to 152.9).

Conclusions

Treatment with bisphosphonates reduced SREs, improved pain control, and showed a trend to increased survival. Bisphosphonates should be used in the treatment of patients with lung cancer and bone metastases.

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Acknowledgments

We would like to thank Ruili Luo, PhD, Yimin Geng, MS, and Hong Zhang, PhD, for their assistance in translating the Chinese language articles. We are grateful to Eduardo Bruera, MD, oncologist at the Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center for his invaluable feedback.

Conflicts of interest

This study was supported in part by a Cancer Center Support Grant (CA016672) from the National Institutes of Health. Dr. Suarez-Almazor has a K24 career award from the National Institute for Arthritis, Musculoskeletal and Skin Disorders (NIAMS; K24 AR53593).

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Authors and Affiliations

  1. Department of General Internal Medicine, MD Anderson Cancer Center, The University of Texas, 1515 Holcombe Blvd, Unit 1499, Houston, TX, 77030-3722, USA

    Maria A. Lopez-Olivo, Nimit A. Shah & Maria E. Suarez-Almazor

  2. Research Medical Library, MD Anderson Cancer Center, The University of Texas, 1515 Holcombe Blvd, Unit 1499, Houston, TX, 77030-3722, USA

    Greg Pratt

  3. School of Public Health, The University of Texas, 1200 Herman Presser, Houston, TX, 77030-3722, USA

    Jan M. Risser & Elaine Symanski

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  1. Maria A. Lopez-Olivo
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  2. Nimit A. Shah
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  6. Maria E. Suarez-Almazor
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Corresponding author

Correspondence to Maria E. Suarez-Almazor.

Appendices

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Table 4 Search strategy
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Appendix 2

Table 5 Definition of outcome measures
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Lopez-Olivo, M.A., Shah, N.A., Pratt, G. et al. Bisphosphonates in the treatment of patients with lung cancer and metastatic bone disease: a systematic review and meta-analysis. Support Care Cancer 20, 2985–2998 (2012). https://doi.org/10.1007/s00520-012-1563-z

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