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Annals of Oncology Advance Access originally published online on March 13, 2006
Annals of Oncology 2006 17(6):986-989; doi:10.1093/annonc/mdl041
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© 2006 European Society for Medical Oncology

Effect of zoledronic acid on pain associated with bone metastasis in patients with prostate cancer

K. P. Weinfurt1,*, K. J. Anstrom1, L. D. Castel1, K. A. Schulman1 and F. Saad2

1 Center for Clinical and Genetic Economics, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA; 2 Centre Hospitalier de l'Université de Montréal, Hôpital Notre-Dame, Montréal, Québec, Canada

* Correspondence to: Prof. K. P. Weinfurt, Center for Clinical and Genetic Economics, Duke Clinical Research Institute, PO Box 17969, Durham, NC 27715, USA. Tel: +1-919-668-8101; Fax: +1-919-668-7124; E-mail: kevin.weinfurt{at}duke.edu

Background: Zoledronic acid reduces skeletal-related events associated with prostate cancer and has long-term efficacy in pain outcomes. Findings of treatment group differences in pain early in treatment are less reliable. We used a recently recommended analytic approach to examine the effect of zoledronic acid on pain.

Materials and methods: In a trial of zoledronic acid (n = 214) versus placebo (n = 208), we used the Brief Pain Inventory to assess pain at baseline, 3 weeks, 6 weeks and every 6 weeks thereafter for a total of 60 weeks. We used a modified longitudinal rank test to determine whether clinically meaningful changes in pain were related to treatment group.

Results: Seventy-six of 214 patients (35.5%) receiving zoledronic acid and 62 of 208 patients (29.8%) receiving placebo completed the 60-week visit (P = 0.22). In all 11 pain assessments, patients receiving zoledronic acid reported more favorable, clinically meaningful changes in pain scores. Overall, patients receiving zoledronic acid had a 33% chance of a favorable response, compared with 25% for patients receiving placebo (P = 0.04; 95% CI 0.5% to 15.6%).

Conclusions: Zoledronic acid was more likely than placebo to be associated with clinically meaningful reductions in pain. Thus, zoledronic acid may help to avert the pain experienced by patients with progressing metastatic disease secondary to prostate cancer.

Key words: antineoplastic agents, bone neoplasms, diphosphonates, pain, prostatic neoplasms, research design


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