Journal of Oncology Pharmacy Practice

Renal Safety of 1 hour Pamidronate Infusion for Breast Cancer and Multiple Myeloma Patients
Mario L de Lemos, Suzanne C Taylor, Jeff B Barnett, Francis Hu, Adeera Levin, Veronika Moravan and Susan E OReilly
J Oncol Pharm Pract 2006 12: 193

Maximino G. Bello, MD Assistant Professor St. Lukes College of Medicine

Medical Oncologist

Purpose
The American Society of Clinical Oncology

recommends infusion of Pamidronate over 2

hours to avoid renal detoriation

There are data to suggest 1 hour infusions

may be safe

Introduction
Bone metastases are a common complication of cancer Pamiodronate belongs to the biphosphonate class of agents
Decrease the risk of skeletal related events

Introduction
Pamidronate is usually infused over an extended period of time
Clinical trials : renal detoriation occurred in 6.7-10% of
with 2 hour infusion of Pamidronate Data suggest risk of renal detoriation may not increase if infused for 1 hour Most cases of renal detoriation seen with high doses, rather than rapid infusion

Method

Population-based, retrospective analysis

Prevalence of renal detoriation was assessed

from the medical records

Study Population
Data base of BC Cancer Agency in October 1999
1. Administered pamidronate for one of the following indications : Breast cancer with bone metastases and unable to tolerate oral clodronate Acute bone pain secondary to metastatic breast cancer Multiple myeloma 2. Administered first pamidronate dose between 1 January 2000 and December 2002 and at least 1 follow up for all cases

3. Treated at one or more of the regional cancer centres of the BC Cancer Agency

Study Outcomes Renal Deteriotion

Primary outcome :
Prevalence deteriotion of renal Overall, 7.7% experienced renal deteriotion

Proportion of patients

with an increase in SrCr

2 times baseline during pamidronate therapy

Study Outcomes Renal Deteriotion

SrCr increase 44.2 umol/L if baseline SrCr < 124 umol/L or an increase in SrCr 2 times baseline during pamidronate therapy SrCr increase > 88,4 umol/L if 15% experienced renal

deterioration, as per absolute

baseline SrCr 124 umol/L, or

an increase in serum Creatinine 2 times baseline during

increase in SrCr

pamidronate therapy

Renal Deteriotion

Base on the cancer types

5% experienced renal deteriotion in breast cancer 28% experienced renal deteriotion in multiple myeloma

Statistical Analysis

Null hypothesis
No difference in the prevalence of renal detoriation between the study patients and that reported in these trials

Results

Pharmacoeconomic Analysis

Conclusion
No significant clinically renal deterioration over 1 hour and 2 hour infusion of Pamidronate Pamidronate 1 hour infusion is less expensive

Thank You