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Bisphosphonates
I mentioned in another comment that my dad has developed a compression fracture. His doctor recommended that he start pamidronate. We were told that he should have a full dental exam before starting pam and that once treatment begins, he should speak with his doctor and dentist before having any dental work done. Are there any other side effects or precautions to be aware of? Thanks!
Re: Bisphosphonates
Dr. Jacob Laubach from the Dana-Farber Cancer Institute said:
"Aredia (pamidronate) and Zometa (zoledronic acid) are intravenous bisphosphonates in the same drug class as the oral drug Fosamax (alendronate). They are used in multiple myeloma and other cancers that involve bone to prevent bone events such as fractures of the long bones or compression fractures of the vertebral bodies. They are an important part of the overall treatment of multiple myeloma for many patients, but have been associated with several side effects which must be monitored while patients undergo treatment.
Osteonecrosis of the jaw is a condition in which the maxilla and/or mandible becomes necrotic and begins to break down. It occurs in roughly 5-15% of myeloma patients receiving intravenous bisphosphonate therapy and appears to be more common following invasive dental work.
As such, it is recommended that patients who will receive an intravenous bisphosphonate be evaluated by a dentist and have necessary dental work done prior to commencing treatment. If a dental procedure is required while a patient is receiving a bisphosphonate, the drug should be discontinued prior to the dental procedure and held for a period of time after the procedure.
Other side effects can occur with the intravenous bisphosphonates as well. These include kidney damage and low calcium. The treating myeloma physician will monitor for both of these conditions closely while a patient is receiving intravenous bisphosphonate."
"Aredia (pamidronate) and Zometa (zoledronic acid) are intravenous bisphosphonates in the same drug class as the oral drug Fosamax (alendronate). They are used in multiple myeloma and other cancers that involve bone to prevent bone events such as fractures of the long bones or compression fractures of the vertebral bodies. They are an important part of the overall treatment of multiple myeloma for many patients, but have been associated with several side effects which must be monitored while patients undergo treatment.
Osteonecrosis of the jaw is a condition in which the maxilla and/or mandible becomes necrotic and begins to break down. It occurs in roughly 5-15% of myeloma patients receiving intravenous bisphosphonate therapy and appears to be more common following invasive dental work.
As such, it is recommended that patients who will receive an intravenous bisphosphonate be evaluated by a dentist and have necessary dental work done prior to commencing treatment. If a dental procedure is required while a patient is receiving a bisphosphonate, the drug should be discontinued prior to the dental procedure and held for a period of time after the procedure.
Other side effects can occur with the intravenous bisphosphonates as well. These include kidney damage and low calcium. The treating myeloma physician will monitor for both of these conditions closely while a patient is receiving intravenous bisphosphonate."
Re: Bisphosphonates
Hi Marie-
Dom was getting monthly 2 hour infusions of Aredia after they found a lesion on his back pre-transplant. Kiddo, it got to the point where he would PLAN on spending the next day in bed.
It wiped him out. Flu-like symptoms. He felt like he'd been hit by a truck the morning after the drip.
Post transplant, they changed him to a 15 minute Zometa infusion every 3 weeks. He's had no ill effects from this form of Bisphosphonate.
""Aredia (pamidronate) and Zometa (zoledronic acid) are intravenous bisphosphonates in the same drug class as the oral drug Fosamax (alendronate)."
Personally, I can not tolerate Fosamax. (for osteoporosis) I didn't mind the effects once per month, but when my prescription program changed, the new company would only allow a different dosage of once per WEEK. Forget it. I quit.
These drugs are pretty tough stuff.... and Fosomax is NOTHING compared to the multiple myeloma drugs!
Dom was getting monthly 2 hour infusions of Aredia after they found a lesion on his back pre-transplant. Kiddo, it got to the point where he would PLAN on spending the next day in bed.
It wiped him out. Flu-like symptoms. He felt like he'd been hit by a truck the morning after the drip.
Post transplant, they changed him to a 15 minute Zometa infusion every 3 weeks. He's had no ill effects from this form of Bisphosphonate.
""Aredia (pamidronate) and Zometa (zoledronic acid) are intravenous bisphosphonates in the same drug class as the oral drug Fosamax (alendronate)."
Personally, I can not tolerate Fosamax. (for osteoporosis) I didn't mind the effects once per month, but when my prescription program changed, the new company would only allow a different dosage of once per WEEK. Forget it. I quit.
These drugs are pretty tough stuff.... and Fosomax is NOTHING compared to the multiple myeloma drugs!
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Nanette - Name: Nanette "Deaux"
- Who do you know with myeloma?: My dear husband, Dominic
- When were you/they diagnosed?: Spring of 2008
- Age at diagnosis: 62
Re: Bisphosphonates
Recent reports stated bisphosphonates have been found to cause fractures. If true, then what therapy is available for multiple myeloma patients?
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Ronne
Re: Bisphosphonates
There have been some reports that implied increased risk of fractures with use of bisphosphonates. But a more comprehensive review of the data from the clinical trials using the bisphosphonates such as alendronate [Fosamax] and zoledronic acid [Zometa], published in New England Journal of Medicine in March 2010, showed that fractures were rare even in those patients who have been treated with bisphosphonates for 10 years. This study did not find the risk of fracture to be higher with bisphosphonates. We should continue to use bisphosphonates in patients with multiple myeloma.
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Dr. Bijay Nair - Name: Bijay Prabhakaran Nair, M.D.
Bisphosphonates - Aredia - Zometa
What is the present "consensus" regarding use of Aredia at medium level of 60-mg/dose per 2-months or some similar regime to reduce or prevent lytic bone lesions in relapsed multiple myeloma cases over several years?
Recently we see numerous articles pro and con using bisphosphonates due to ONJ, bone embrittlement (and prospectively even secondary cancer correlations) - yet the apparent benefits of delaying bone lysis, vertebrea collapse and bone pain seem compelling.
Who does the patient turn to when the Hematologist-oncologist and MM-oncologist have divergent views? --
Case in point is a patient 10 years post allo-BMT (first 5 years with 90-mg/month Aredia and no signs of ONJ or bone embrittlement) who relapsed in 2005 and has since had 5 relapses with medulary and extramedulary plasmacytomas [radiated as needed] and almost constant chemotherapy [singly and combos with Thalidomide, Velcade, Revlimid, Cytoxan, Dexamethasone] but no bisphosphonates. Is it prudent to restart Aredia?
Regards, EbbeSkov
Recently we see numerous articles pro and con using bisphosphonates due to ONJ, bone embrittlement (and prospectively even secondary cancer correlations) - yet the apparent benefits of delaying bone lysis, vertebrea collapse and bone pain seem compelling.
Who does the patient turn to when the Hematologist-oncologist and MM-oncologist have divergent views? --
Case in point is a patient 10 years post allo-BMT (first 5 years with 90-mg/month Aredia and no signs of ONJ or bone embrittlement) who relapsed in 2005 and has since had 5 relapses with medulary and extramedulary plasmacytomas [radiated as needed] and almost constant chemotherapy [singly and combos with Thalidomide, Velcade, Revlimid, Cytoxan, Dexamethasone] but no bisphosphonates. Is it prudent to restart Aredia?
Regards, EbbeSkov
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EbbeSkov
Re: Bisphosphonates
Dr. William Bensinger from the Fred Hutchinson Cancer Research Center said:
"Difficult issue, lots of different opinions but very little solid data to guide a person.
I think in general that a person with active myeloma benefits from regular bisphosphonates due to the protection from lytic bone disease. Exactly what dose and schedule is recommended is debatable. The risks of ONJ are outweighed by the protection from skeletal bone disease."
"Difficult issue, lots of different opinions but very little solid data to guide a person.
I think in general that a person with active myeloma benefits from regular bisphosphonates due to the protection from lytic bone disease. Exactly what dose and schedule is recommended is debatable. The risks of ONJ are outweighed by the protection from skeletal bone disease."
Re: Bisphosphonates
My husband started getting pamidronate one year after diagnosis. At this time the only symptom that was evident to us was a tiny bit of anemia. (there must have been other markers in the blood as well for the doctors to make the diagnosis) He got the pamidronate initially every 3 months and then it was scaled back to every 4 months. This lasted up until his stem cell transplant last August - he received the treatment for about 5 years. He has no bone complications and his doctor feels that it is because of the pamidronate. All the tests come back showing that he has great bones. In fact shortly before the transplant he had a very nasty fall while hiking and there was no bone breakage.
My husband got really rigors after each treatment and it is quite amusing to us now to think that he was thinking of going off of the treatment because of this. Those side effects were nothing compared to the stem cell transplant and certainly nothing compared to having your bones break.
Pamidronate caused him no complications.
My husband got really rigors after each treatment and it is quite amusing to us now to think that he was thinking of going off of the treatment because of this. Those side effects were nothing compared to the stem cell transplant and certainly nothing compared to having your bones break.
Pamidronate caused him no complications.
Re: Bisphosphonates
Beacon Staff wrote:Dr. William Bensinger from the Fred Hutchinson Cancer Research Center said:
"Difficult issue, lots of different opinions but very little solid data to guide a person.
I think in general that a person with active myeloma benefits from regular bisphosphonates due to the protection from lytic bone disease. Exactly what dose and schedule is recommended is debatable. The risks of ONJ are outweighed by the protection from skeletal bone disease."
I asked a number of questions about why and how often to use bisphosphonates during an interview with Dr. Brian Durie, Cedars-Sinai Cancer Center in LA, last December. He stressed the anti-myeloma properties and, as Dr. William Bensinger wrote above, "a person with active myeloma benefits from regular bisphosphonates due to the protection from lytic bone disease." I agree with Dr. Bensinger. The benefits of using Zometa or Aredia outweigh the risks in most cases. After three years, I only receive an Aredia IV every two or three months. But since I had so much bone involvement at the time of my initial diagnosis, I feel periodic treatment is a good idea.
Pat Killingsworth
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Pat Killingsworth - Name: Pat Killingsworth
- Who do you know with myeloma?: I am a multiple myeloma patient
- When were you/they diagnosed?: April, 2007
- Age at diagnosis: 51
Re: Bisphosphonates
And overall, the data supporting the use of bisphosphonates was published when thalidomide, Revlimid, and Velcade were not in prime time. The effectiveness (decrease in fractures) need to be re-examined in an era of "novel drugs". That said, the osteonecrosis of the jaw also should be studied more stringently in the era of, ideally, better oral hygiene.
Luckily there are new and ideally more effective medications coming with RANK ligand inhibitors (ex. denosumab) and DKK1-inhibitors (ex. BHQ-880). Stay tuned
Luckily there are new and ideally more effective medications coming with RANK ligand inhibitors (ex. denosumab) and DKK1-inhibitors (ex. BHQ-880). Stay tuned
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Dr. Craig Hofmeister - Name: Craig C. Hofmeister, M.D.
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