课件：双膦酸盐在肺癌中骨转移的进展.ppt

Bisphosphonates Overview * 这些大型临床研究证实，择泰可以对所用的实体肿瘤和骨髓瘤患者的骨质破坏或者高钙血症都有显著疗效。因此，择泰被批准适用于所用实体肿瘤和骨髓瘤的高钙血症和骨质破坏的患者。 我们先来了解一下《肿瘤学年报》，它是欧洲临床肿瘤学会（ESMO）和日本临床肿瘤学会（JSMO）官方期刊，《国际专家委员会双膦酸盐治疗实体瘤应用指南》于2008年2月发表于《肿瘤学年报》上，指南具体是怎么推荐的呢？《国际专家委员会双膦酸盐治疗实体瘤应用指南》中说：“肺癌骨转移患者和逻辑上可以从中获益的患者（如预期存活时间，患者的状况等）应该考虑使用唑来膦酸；其他双膦酸盐没推荐” * 《2010年性肿瘤骨转移及骨相关疾病临床诊疗专家共识》中指出：“唑来膦酸是目前全球唯一获批肺癌骨转移治疗适应症的双膦酸盐，能有效预防或延缓肺癌骨转移（包括溶骨性和成骨性）引起的SREs，治疗骨转移引起的骨相关事件。”共识同时推荐，肺癌骨转移患者应早期、长期使用双膦酸盐治疗。 * * 一向回顾性研究同时证实：肺癌骨转移患者早期、长期、规律使用择泰?，带来更多获益。 首先，临床研究证实：在确诊骨转移之后即开始择泰?治疗，显著延缓SREs发生。 该研究入选4546例至少发生一处骨转移的恶性肿瘤患者（其中乳腺癌46.1%、前列腺癌34.2%和肺癌24.0%），回顾性分析择泰?使用频率和SREs发生率的关系。研究结果显示：确诊后立即用择泰?治疗组较确诊后无双膦酸盐治疗组延迟第一次和第二次骨相关事件发生时间。 BACKGROUND. Bone is among the most common sites of metastasis in patients with advanced cancer, and the development of bone metastases places patients at increased risk for skeletal complications. METHODS. This retrospective claims analysis included only patients with a diagnosis of bone metastasis who had a single type of solid tumor of the breast (women), prostate, or lung and experienced 1 skeletal complication between January 2002 and October 2005. RESULTS. The mean follow-up (standard deviation) for zoledronic acid (ZA)- treated patients versus untreated patients was 12.2 9.05 months versus 8.7 9.28 months, respectively (P .001). The monthly rate of skeletal complications in ZA-treated patients versus untreated patients was 0.29 0.3 per month versus 0.43 0.4 per month, respectively (P .001). Persistent ZA use was associated with longer follow-up duration (P .05) and a greater probability of continuing follow-up. Greater persistency was associated with lower monthly rates of skeletal complications (P .05). The length of follow-up for ZA use according to the recommended dosing schedule was 17.11 months compared with 9.93 months for nonrecommended schedules and 8.68 months for no treatment (analysis of variance; P .001). The rate of skeletal complications with ZA use on the recommended schedule was 0.16 ev