I would be very careful of Zometa. You were wise to have all of your dental work done. My husband didn't and got osteonecrosis of the jaw within 3 months. His oncologist continued to treat because he believed it treated the multiple myeloma also.
After two years we changed to another oncologist who took him off the drug. The drug has a long half life and after 4 years he still hasn't had any lesions that we know of. He has continual problems with the osteonecrosis and no one wants to deal with it. It will never go away. I think two years is plenty.
Forums
Re: Zometa - how often and for how long?
I've been on Zometa two separate times, each for a minimum of 2 years.
The first treatment made me sicker than chemo. I hurt everywhere. I had fever and chills and literally crawled around my house. That lasted a good 2 weeks. After that first intense horrible reaction, I've had no issues at all. In fact, as I reached the end of each month and it was time for the next treatment, my discomfort would start to build and a day after the treatment I felt much better. It did help my bone pain.
Just finished my second 2-year round. Starting chemotherapy for third time next week. All prayers appreciated.
The first treatment made me sicker than chemo. I hurt everywhere. I had fever and chills and literally crawled around my house. That lasted a good 2 weeks. After that first intense horrible reaction, I've had no issues at all. In fact, as I reached the end of each month and it was time for the next treatment, my discomfort would start to build and a day after the treatment I felt much better. It did help my bone pain.
Just finished my second 2-year round. Starting chemotherapy for third time next week. All prayers appreciated.
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Linda424
Re: Zometa - how often and for how long?
I thought I would post this study with respect to frequency of taking Zometa. I am on a quarterly schedule and have had no new bone events despite significant bone damage at diagnosis.
Abstract:
Importance: Zoledronic acid, a third-generation aminobisphosphonate, reduces the incidence of skeletal-related events and pain in patients with bone metastases. The optimal dosing interval for zoledronic acid is uncertain.
Objective: To determine whether zoledronic acid administered every 12 weeks is noninferior to zoledronic acid administered every 4 weeks.
Design, Setting, Participants: Randomized, open-label clinical trial conducted at 269 academic and community sites in the United States. Patients (n = 1822) with metastatic breast cancer, metastatic prostate cancer, or multiple myeloma who had at least 1 site of bone involvement were enrolled between May 2009 and April 2012; follow-up concluded in April 2014.
Interventions: Patients were randomized to receive zoledronic acid administered intravenously every 4 weeks (n = 911) vs every 12 weeks (n = 911) for 2 years.
Main Outcomes and Measures: The primary end point was the proportion of patients having at least 1 skeletal-related event (defined as clinical fracture, spinal cord compression, radiation to bone, or surgery involving bone) within 2 years after randomization and a between-group absolute difference of 7% as the noninferiority margin. Secondary end points included the proportion of patients with at least 1 skeletal-related event by disease type, pain as assessed by the Brief Pain Inventory (range, 0-10; higher scores indicate worse pain), Eastern Cooperative Oncology Group performance status (range, 0-4; higher scores indicate worse disability), incidence of osteonecrosis of the jaw, kidney dysfunction, skeletal morbidity rate (mean number of skeletal-related events per year), and, in a subset of 553 patients, suppression of bone turnover (assessed by C-terminal telopeptide levels).
Results: Among 1822 patients who were randomized (median age, 65 years; 980 [53.8%] women; 855 with breast cancer, 689 with prostate cancer, and 278 with multiple myeloma), 795 completed the study at 2 years. A total of 260 patients (29.5%) in the zoledronic acid every 4-week dosing group and 253 patients (28.6%) in the every 12-week dosing group experienced at least 1 skeletal-related event within 2 years of randomization (risk difference of -0.3% [1-sided 95% CI, -4% to ∞]; P < .001 for noninferiority). The proportions of skeletal-related events did not differ significantly between the every 4-week dosing group vs the every 12-week dosing group for patients with breast cancer, prostate cancer, or multiple myeloma. Pain scores, performance status scores, incidence of jaw osteonecrosis, and kidney dysfunction did not differ significantly between the treatment groups. Skeletal morbidity rates were numerically identical in both groups, but bone turnover was greater (C-terminal telopeptide levels were higher) among patients who received zoledronic acid every 12 weeks.
Conclusions and Relevance: Among patients with bone metastases due to breast cancer, prostate cancer, or multiple myeloma, the use of zoledronic acid every 12 weeks compared with the standard dosing interval of every 4 weeks did not result in an increased risk of skeletal events over 2 years. This longer interval may be an acceptable treatment option.
Source:
Himelstein, AL, et al, "Effect of Longer-Interval vs Standard Dosing of Zoledronic Acid on Skeletal Events in Patients With Bone Metastases: A Randomized Clinical Trial," Journal of the American Medical Association, Jan 3, 2013 (abstract at PubMed)
Abstract:
Importance: Zoledronic acid, a third-generation aminobisphosphonate, reduces the incidence of skeletal-related events and pain in patients with bone metastases. The optimal dosing interval for zoledronic acid is uncertain.
Objective: To determine whether zoledronic acid administered every 12 weeks is noninferior to zoledronic acid administered every 4 weeks.
Design, Setting, Participants: Randomized, open-label clinical trial conducted at 269 academic and community sites in the United States. Patients (n = 1822) with metastatic breast cancer, metastatic prostate cancer, or multiple myeloma who had at least 1 site of bone involvement were enrolled between May 2009 and April 2012; follow-up concluded in April 2014.
Interventions: Patients were randomized to receive zoledronic acid administered intravenously every 4 weeks (n = 911) vs every 12 weeks (n = 911) for 2 years.
Main Outcomes and Measures: The primary end point was the proportion of patients having at least 1 skeletal-related event (defined as clinical fracture, spinal cord compression, radiation to bone, or surgery involving bone) within 2 years after randomization and a between-group absolute difference of 7% as the noninferiority margin. Secondary end points included the proportion of patients with at least 1 skeletal-related event by disease type, pain as assessed by the Brief Pain Inventory (range, 0-10; higher scores indicate worse pain), Eastern Cooperative Oncology Group performance status (range, 0-4; higher scores indicate worse disability), incidence of osteonecrosis of the jaw, kidney dysfunction, skeletal morbidity rate (mean number of skeletal-related events per year), and, in a subset of 553 patients, suppression of bone turnover (assessed by C-terminal telopeptide levels).
Results: Among 1822 patients who were randomized (median age, 65 years; 980 [53.8%] women; 855 with breast cancer, 689 with prostate cancer, and 278 with multiple myeloma), 795 completed the study at 2 years. A total of 260 patients (29.5%) in the zoledronic acid every 4-week dosing group and 253 patients (28.6%) in the every 12-week dosing group experienced at least 1 skeletal-related event within 2 years of randomization (risk difference of -0.3% [1-sided 95% CI, -4% to ∞]; P < .001 for noninferiority). The proportions of skeletal-related events did not differ significantly between the every 4-week dosing group vs the every 12-week dosing group for patients with breast cancer, prostate cancer, or multiple myeloma. Pain scores, performance status scores, incidence of jaw osteonecrosis, and kidney dysfunction did not differ significantly between the treatment groups. Skeletal morbidity rates were numerically identical in both groups, but bone turnover was greater (C-terminal telopeptide levels were higher) among patients who received zoledronic acid every 12 weeks.
Conclusions and Relevance: Among patients with bone metastases due to breast cancer, prostate cancer, or multiple myeloma, the use of zoledronic acid every 12 weeks compared with the standard dosing interval of every 4 weeks did not result in an increased risk of skeletal events over 2 years. This longer interval may be an acceptable treatment option.
Source:
Himelstein, AL, et al, "Effect of Longer-Interval vs Standard Dosing of Zoledronic Acid on Skeletal Events in Patients With Bone Metastases: A Randomized Clinical Trial," Journal of the American Medical Association, Jan 3, 2013 (abstract at PubMed)
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Mark11
Re: Zometa - how often and for how long?
Good stuff Mark. The study does beg the question of how a biannual or annual Zometa schedule would compare with the monthly and quarterly schedule results?
It makes sense that the quarterly treatment cohort had higher bone turnover than the monthly treatment cohort since reducing bone turnover is a key function of Zometa. A quick scan of the literature seems to indicate that higher bone turnover in cancer patients leads to increased skeletal issues - but this doesn't seem to be the case in this study. Curious.
It makes sense that the quarterly treatment cohort had higher bone turnover than the monthly treatment cohort since reducing bone turnover is a key function of Zometa. A quick scan of the literature seems to indicate that higher bone turnover in cancer patients leads to increased skeletal issues - but this doesn't seem to be the case in this study. Curious.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Zometa - how often and for how long?
Interesting. I wonder whether the different dosage schedules has an impact on the likelihood of developing osteonecrosis of the jaw (ONJ)?
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goldmine848 - Name: Andrew
- When were you/they diagnosed?: June 2013
- Age at diagnosis: 60
Re: Zometa - how often and for how long?
Thanks Mark for posting the abstract of this study. I may need to go on bisphosphonates again if I take anti-hormone treatments! I am also worried about ONJ, so can ask my medical oncologist about the tiimings between treatments.
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Nancy Shamanna - Name: Nancy Shamanna
- Who do you know with myeloma?: Self and others too
- When were you/they diagnosed?: July 2009
Re: Zometa - how often and for how long?
Thanks for posting about the study, Mark.
Andrew and Nancy - The incidence of osteonecrosis of the jaw (ONJ) was similar between the different treatment groups. Here's the key text from the "Results" part of the abstract:
"Pain scores, performance status scores, incidence of jaw osteonecrosis, and kidney dysfunction did not differ significantly between the treatment groups."
Andrew and Nancy - The incidence of osteonecrosis of the jaw (ONJ) was similar between the different treatment groups. Here's the key text from the "Results" part of the abstract:
"Pain scores, performance status scores, incidence of jaw osteonecrosis, and kidney dysfunction did not differ significantly between the treatment groups."
Re: Zometa - how often and for how long?
Thanks Terry H for the clarification regarding osteonecrosis of the jaw (ONJ) in the above mentioned study. I guess the main finding of the study was that the incidence of adverse skeletal events did not change between the 4-week or 12-week infusions. When I took infusions of Aredia (pamidronate) over a period of two and a half or three years, it was started with once every four weeks, then once every 8 weeks, and eventually every 12 weeks. So I know that the times between treatments can be varied.
"Conclusions and Relevance: Among patients with bone metastases due to breast cancer, prostate cancer, or multiple myeloma, the use of zoledronic acid every 12 weeks compared with the standard dosing interval of every 4 weeks did not result in an increased risk of skeletal events over 2 years. This longer interval may be an acceptable treatment option."
"Conclusions and Relevance: Among patients with bone metastases due to breast cancer, prostate cancer, or multiple myeloma, the use of zoledronic acid every 12 weeks compared with the standard dosing interval of every 4 weeks did not result in an increased risk of skeletal events over 2 years. This longer interval may be an acceptable treatment option."
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Nancy Shamanna - Name: Nancy Shamanna
- Who do you know with myeloma?: Self and others too
- When were you/they diagnosed?: July 2009
Re: Zometa - how often and for how long?
Should I change my Zometa infusion schedule based on the article Mark posted about last month, earlier in this thread?
I just started monthly infusions and was going to speak with my specialist about having quarterly infusions instead.
I just started monthly infusions and was going to speak with my specialist about having quarterly infusions instead.
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jrj001 - Name: Jim
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: 3/15
- Age at diagnosis: 61
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