Resumen
Hasta hace poco tiempo, el tratamiento estándar para la hipercalcemia asociada a procesos malignos fue la administración endovenosa de 90 mg de pamidronato. A pesar de esto, el análisis conjunto efectuado durante el año 2001 de dos trabajos paralelos, multicéntricos, aleatorizados y a doble ciego demostró que 4 mg de ácido zoledrónico tuvieron una respuesta superior a 90 mg de pamidronato. En estas pruebas, 287 pacientes con hipercalcemia moderada a severa a consecuencia de procesos malignos (la cual se definió por una concentración de calcio sérico corregido ≥ 3.00 mmol/l (12.0 mg/dl)), fueron tratados con una dosis simple de ácido zoledrónico (perfusión durante 5 minutos de 4 mg u 8 mg) o con pamidronato (perfusión durante 2 horas de 90 mg); se obtuvo una respuesta superior con la primera de estas drogas independientemente de las dosis en estudio. Al décimo día de tratamiento, 88% de los pacientes tratados con 4 mg de ácido zoledrónico vs. 70% de los que recibieron pamidronato tuvieron normalización completa del calcio sérico corregido (p = 0.002). Además, la duración de la respuesta fue mayor en los individuos tratados con 4 mg u 8 mg de ácido zoledrónico respecto de los que recibieron 90 mg de pamidronato, con valores de 32, 43 y 18 días, respectivamente. El ácido zoledrónico proporciona normalización más rápida y efectiva del calcio sérico y respuesta de mayor duración, motivo por el cual es considerado (en la dosis recomendada de 4 mg) el nuevo tratamiento estándar.
Palabras clave
Bisfosfonato, marcador óseo, resorción ósea, hipercalcemia, ácido zoledrónico.
Clasificación en siicsalud
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página www.siicsalud.com/des/des031/03422002.htm
Especialidades
Principal: Oncología
Relacionadas: Farmacología, Medicina Interna
Enviar correspondencia a:
Pierre P. Major, MD. Hamilton Regional Cancer Centre, 699 Concession Street, Hamilton, Ontario L8V 5C2, Canadá
Patrocinio y reconocimiento
Financiado por Novartis Pharma AG
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ZOLEDRONIC ACID IS THE NEW STANDARD OF CARE FOR THE TREATMENT OF HYPERCALCEMIA OF MALIGNANCY
Abstract
Until recently, the standard of care for the treatment of hypercalcemia of malignancy was intravenous administration of 90 mg pamidronate. However, in 2001, the pooled analysis of 2 parallel, multicenter, randomized, double-blind trials demonstrated that 4 mg zoledronic acid was superior to 90 mg pamidronate. In these trials, 287 patients with moderate to severe hypercalcemia of malignancy, defined as corrected serum calcium ( 3.00 mmol/L (12.0 mg/dL), were treated with either a single dose of zoledronic acid (4 or 8 mg via 5-minute infusion) or pamidronate (90 mg via 2-hour infusion). Both doses of zoledronic acid were superior to pamidronate. By Day 10, 88% of patients treated with 4 mg zoledronic acid versus 70% of patients treated with pamidronate had complete normalization of corrected serum calcium (P = .002). Moreover, the median duration of complete response favored zoledronic acid 4 and 8 mg over pamidronate 90 mg, with response durations of 32, 43, and 18 days, respectively. Zoledronic acid provides a more rapid and effective normalization of serum calcium and a longer duration of response compared with 90 mg pamidronate. Therefore, zoledronic acid (at a recommended dose of 4 mg) is the new standard of care.
Key words
Bisphosphonate, bone marker, bone resorption, hypercalcemia, zoledronic acid.
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Bibliografía del artículo
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