New Currents in Treatment of Bone Metastases: A Case-Based Approach

Welcome to part 5 of the 5-part case-based series.

This Tx Reporter series discusses the use of bisphosphonates to help prevent skeletal-related events in patients with bone metastases from solid tumors. This fifth issue includes the case of a 56-year-old lung cancer patient who develops bone metastases. This continuing professional education activity also includes the enclosed audio CD, in which Dr. Green discusses:

The epidemiology and impact of bone metastases in lung cancer patients
The risk and clinical relevance of hypercalcemia
Use of the bisphosphonates pamidronate and zoledronic acid in hypercalcemia of malignancy
The importance of screening patients with lung cancer for skeletal involvement
The rationale for using bisphosphonates in metastatic lung cancer, despite the short life expectancy
The relevance of multiple event analysis in studies of bisphosphonates
Preclinical evidence of synergistic effects between bisphosphonates and chemotherapy
Appropriate candidates for bisphosphonate therapy
The duration of bisphosphonate therapy
The safety profile of bisphosphonates
Future directions in the study of bisphosphonates in lung cancer

Dear Colleague:

Bone metastases develop in approximately 30% to 65% of patients with metastatic lung cancer. Skeletal-related events (SREs), such as bone pain, pathologic fractures, spinal cord compression, and hypercalcemia of malignancy (HCM), complicate the clinical course of lung cancer in many patients. New data indicate that the bisphosphonate, zoledronic acid, reduces the risk of SREs in patients with bone metastases from lung and other solid tumors. These data and their implications for clinical practice are described in this final Tx Reporter in the series, New Currents in Treatment of Bone Metastases: A Case-Based Approach.

The first part of this 5-part Tx Reporter series was an overview of bone metastases and bisphosphonates. This was followed by case-based newsletters on bone metastases in breast cancer (Part 2), prostate cancer (Part 3), and renal cell carcinoma (Part 4). This series concludes here with the case of a lung cancer patient with bone metastases. This 5-part series allows an in-depth look at specific patient populations and information on applying the data on bisphosphonates to actual clinical practice.

Each issue is an independent CME activity consisting of a Tx Reporter newsletter and an audio CD featuring an interview of the expert faculty on related issues. Each issue is also accompanied by a recent reprint with information that has largely determined the current standard of care. This series focuses on the next generation of bisphosphonate therapy. However, fair balance is critical to this discussion, and the faculty and I also present data on other bisphosphonates.

I hope that you enjoy the series and find it helpful and informative.

Yours truly,

Chair
James R. Berenson, MD
Chief Executive Officer
Institute for Myeloma and
Bone Cancer Research
Los Angeles, California

Faculty
Mark R. Green, MD
Gilbreth Professor of Clinical Oncology
Medical University of South Carolina
Charleston, South Carolina Green

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Target Audience
This activity is designed for oncologists and oncologic healthcare professionals who treat patients with bone metastases.

Activity Goal
The goal of this activity is to provide an overview of bone metastases and the latest developments in preventing related skeletal complications using bisphosphonate therapies.

Learning Objectives
After participating in this activity, the participant should be able to:

Describe the complications imposed by bone metastases in the clinical management of lung cancer.
Discuss the safety and efficacy of currently available agents and next generation bisphosphonates.
Consider the use of intravenous therapy in the treatment armamentarium to delay and reduce skeletal complications of bone metastases in patients with lung cancer.

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CME Information
Accreditation for Physicians
Projects In Knowledge is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Projects In Knowledge designates this educational activity for a maximum of 1 category 1 credit toward the AMA Physician’s Recognition Award. Each physician should claim only those credits that he/she actually spent in the activity.

This activity is planned and implemented as an independent CME activity in accordance with the ACCME Essential Areas and Policies.

Successful completion for 1 hour of CME credit in this newsletter/CD activity requires a passing score of 70% or higher on the posttest. Full instructions for submission are included on the posttest.

CPE Information
Accreditation for Pharmacists
Projects In Knowledge is accredited by the Accreditation
Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education. This activity has been planned and implemented in accordance with the ACPE Criteria for Quality and Interpretive Guidelines. The ACPE Universal Program Number assigned to this program, for 1 contact hour (0.1 CEU), is 052-000-03-057-H01.

CE Information
Accreditation for Nurses
The National Center for Advanced Medical Education (a division of CMEinfo.com) is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. The National Center for Advanced Medical Education (a division of CMEinfo.com) designates this educational activity for 1.2 contact hours. Provider approved by the California Board of Registered Nursing, Provider Number 13776 for 1.2 contact hours.

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Disclosure Information

The Disclosure Policy of Projects In Knowledge and The National Center for Advanced Medical Education (a division of CMEinfo.com) requires that faculty participating in a CME/CPE/CE activity disclose to the audience: any significant relationship they may have with a pharmaceutical or medical equipment company, product, or service that may be mentioned as part of their presentation; any relationship with the commercial supporter of this activity; if discussion includes: 1) therapies that are unapproved for use or are investigational; 2) ongoing research; or 3) preliminary data. Faculty will disclose such discussion.

For complete prescribing information on the products described during this CME activity, please see your current Physicians' Desk Reference (PDR).

James R. Berenson, MD, has received grant/research support from Amgen Inc, Chugai Pharmaceuticals Company, Millennium Pharmaceuticals, Inc, and Novartis Pharmaceuticals Corporation. Susan Bove, MSN, APRN, BC, has no significant relationships with industry. Mark R. Green, MD, is a consultant for Novartis Pharmaceuticals Corporation. Christine Wilson, PhD, APRN, BC, NP-C, is on the speakers bureau of Bristol-Myers Squibb Company; and is a stock shareholder in Pfizer Inc.

The opinions expressed in this activity are those of the faculty and do not necessarily reflect those of Projects In Knowledge or The National Center for Advanced Medical Education (a division of CMEinfo.com).

This CME/CPE activity is provided by Projects In Knowledge, and the CE activity is provided by The National Center for Advanced Medical Education (a division of CMEinfo.com) solely as an educational service. Please note that although faculty will discuss specific treatment modalities, neither Projects In Knowledge, the accredited and approved CME provider, nor The National Center for Advanced Medical Education (a division of CMEinfo.com), the accredited and approved CE provider, nor their CME/CE regulatory bodies, including the ANCC, endorse any of the modalities mentioned in the course of discussion. Specific patient care decisions are the responsibility of the healthcare professional caring for the patient.

This independent CME/CPE/CE activity is supported by an educational grant from Novartis Pharmaceuticals Corporation.

Nurse Planner: Christine Wilson, PhD, APRN, BC, NP-C, Visiting Assistant Professor, University of South Florida, Tampa, Florida.
Nurse Reviewer: Susan Bove, MSN, APRN, BC, Private Practice, Reading, Massachusetts.

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