gms | German Medical Science

Aims of investigation: Metastatic bone disease in urological malignancies is associated with challenging clinical problems such as bone pain, pathological fractures and spinal-cord compression. Ibandronate is a single nitrogen-containing bisphosphonate which reduced bone pain for up to 2 years in patients with breast cancer and bone metastases. Rapid pain relief is important, therefore we evaluated the efficacy and safety of loading-dose ibandronate for patients with painful bone metastases due to urological cancer in a pilot study.

Methods: Fifty-three patients with painful osseous metastases due to prostate, renal and bladder cancer were included in this prospective study. All patients had a serum creatinine level greater than 2mg/dL and a mean VAS pain score of 6.8. Intravenous ibandronate 6mg was given on 3 consecutive days, and continued at 4-week intervals. Pain was assessed using a visual analog scale (VAS) from 0 = no pain to 10 = maximum pain. The Karnofsky scale measured patient functioning.

Results: Bone pain was rapidly and significantly improved in 44/53 (83%) of the patients, starting on day 2. Twenty-five percent of patients were completely pain free. The mean pain score on day 3 was 2.5 (p<0.001 vs baseline). Mean bone pain scores remained below baseline for 20 weeks and were accompanied by improved patients functioning. No patients demonstrated an increase in serum creatinine or serum urea nitrogen concentrations and no renal adverse events were reported.

Conclusions: Loading-dose intravenous ibandronate results in a rapid, long-lasting and significant pain relieving effect in patients with painful osseous metastases due to urologic cancer. Furthermore, loading-dose ibandronate enabled bedridden patients to regain mobility in 3 days (as evidence by Karnofsky scale changes). Renal safety was not compromised.