雙磷酸鹽藥物於癌症骨轉移的治療應用

Effect of Bisphosphonates in Patients with Bone Metastases

吳凱文(Karl Wu) ； 陳致宇(Chih-Yu Chen) ； 張至宏(Chih-Hung Chang) ； 楊榮森(Rong-Sen Yang)

《台灣老年醫學暨老年學雜誌》 5卷1期 (2010/02) Pp. 1-12

https://doi.org/10.29461/TGG.201002.0001

摘要

骨骼是末期腫瘤轉移最常見的部位之一。骨轉移會破壞骨骼動態平衡，並導致各種病況及骨骼併發症，包括病理性骨折、骨骼疼痛、高血鈣及脊神經壓迫等。雙磷酸鹽類藥物可以緩解骨骼疼痛和避免骨骼相關併發症。這些情形嚴重影響病患的活動能力，並減低其生活品質。治療骨轉移的方法，包括輻射治療、止痛藥物、手術和雙磷鹽藥物。
由於雙磷鹽藥物會與骨表面結合，進而抑制破骨細胞活性，可以減少骨轉移造成的蝕骨作用。不同種類的雙磷酸鹽類有不同的保護強度，其中以含氮雙磷酸鹽有較高效力。大部份雙磷酸鹽類藥物都有相當程度的止痛效果，其中zoledronic acid是迄今唯一被報告可預防、減少、延遲多種腫瘤骨骼併發症的藥物，雙磷酸鹽除可減少嚴重骨骼病變外，並可減輕多種實質腫瘤引起的疼痛。
在所有腫瘤骨轉移患者皆可考慮使用雙磷酸鹽，特別是已經出現症狀的患者。與其他癌症治療相較之下，雙磷酸鹽類藥物的副作用不多且較輕微，但仍需注意腎臟毒性和下顎骨壞死等副作用；大部份下顎骨壞死副作用可在遵守建議劑量、給藥速率和良好牙科治療下降低發生率。本文將回顧雙磷酸鹽藥物於骨轉移病灶的臨床應用、使用效益及使用準則。

關鍵字

雙磷酸鹽物 ； 骨轉移病灶 ； 骨骼疼痛

並列摘要

Bone is one of the most common organs for distant metastases in advanced cancers. Bone metastases disrupt the balance of dynamic bone metabolism and result in considerable morbidity as well as skeletal complications including pathologic fractures, bone pain, hypercalcemia, and spinal cord compression. These conditions will severely impair mobility and decrease the patients' quality of life. Palliative options for treating bone metastases include radiotherapy, analgesics, surgery and bisphosphonates.
Bisphosphonates can bind to the surface of the bone and impair osteoclast-mediated bone resorption and reduce the tumor-associated osteolysis initiated by the development of skeletal metastases. Different kinds of bisphosphonates vary in terms of potency. Nitrogen-containing bisphosphonates report considerably greater efficacy than early-generation agents. Zoledronic acid is so far the only bisphosphonate proven to be capable of preventing, decreasing or delaying the development of various skeletal complications caused by tumors. Bisphosphonates can be considered as a treatment option in all patients with bone metastases. In addition to preventing skeletal-related conditions, bisphosphonates can further relieve bone pain caused by a variety of solid tumors.
When compared to other cancer therapies, bisphosphonates in general trigger milder and less frequent adverse events. However, some complications, such as renal dysfunction and bisphosphonate-related osteonecrosis of the jaw, still warrant monitoring. Most complications can be prevented through adherence to the recommended dose, administration rate, and careful dental treatment. The clinical applications, cost-effectiveness, and principles of using bisphosphonates in patients with bone metastasis are reviewed in the paper.

並列關鍵字

bisphosphonates ； bone metastases ； bone pain ； zoledronic acid