Safety and Convenience of a 15-Minute Infusion of Zoledronic Acid

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Abstract
Learning Objectives: After completing this course, the reader will be able to: Describe the effects of bisphosphonates on bone metabolism in patients with metastatic bone disease. Explain the ability of intravenous bisphosphonates to reduce skeletal complications in patients with metastatic bone disease. Identify differences among the different bisphosphonates in their efficacies at reversing hypercalcemia of malignancy. Access and take the CME test online and receive 1 hour of AMA PRA category 1 credit at CME.TheOncologist.com Skeletal morbidity, including hypercalcemia of malignancy (HCM), places a severe burden on patients with advanced cancers. Bisphosphonates effectively correct HCM and reduce skeletal morbidity in patients with bone metastases. However, with the widespread use of bisphosphonates, the safety and convenience of therapy are emerging concerns. The delivery of effective doses of early bisphosphonates required a lengthy 24-hour i.v. infusion protocol because of renal tolerability issues. The introduction of more potent bisphosphonates with superior tolerability profiles has allowed therapy to be safely delivered via shorter i.v. infusions. Intravenous therapy with etidronate, clodronate, pamidronate, ibandronate, and zoledronic acid has been used to treat HCM and skeletal complications in cancer patients. Of these therapies, zoledronic acid (which can be safely administered via a 15-minute i.v. infusion) is the most convenient and effective and has demonstrated an excellent safety profile with long-term use. Zoledronic acid has also received the broadest regulatory approval of any bisphosphonate and can be used to treat HCM or bone lesions secondary to multiple myeloma and a wide variety of solid tumors, including breast, prostate, and lung cancers. In addition to the patient preference for shorter infusion times, the 15-minute i.v. infusion protocol of zoledronic acid can provide benefits for infusion centers by potentially increasing patient throughput.