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Renal safety of 1-hour pamidronate infusion for breast cancer and multiple myeloma patients: comparison between clinical trials and population-based database

Provincial Drug Information Co-ordinator, Provincial Systemic Therapy Program, British Columbia Cancer Agency, 600 West 10th Avenue, Vancouver, BC, V5Z 4E6, Canada; mdelemos{at}bccancer.bc.ca

Suzanne C Taylor, BSc (Pharm), PharmD, BCPS, FCSHP

Jeff B Barnett, BSc (Pharm), FCSHP

Francis Hu, BSc (Pharm), MBA

Provincial Systemic Therapy Program, British Columbia Cancer Agency, Vancouver, BC, Canada

Adeera Levin, MD, FRCPC

British Columbia Provincial Renal Agency, Vancouver, BC, Canada

Veronika Moravan, MSc

Population and Preventive Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada

Susan E O'Reilly, MB, FRCPC

Provincial Systemic Therapy Program, British Columbia Cancer Agency, Vancouver, BC, Canada

Purpose. The American Society of Clinical Oncology recommends infusion of pamidronate over 2 hours to avoid renal deterioration, although there are data to suggest that 1-hour infusions may be safe.

Methods, Prevalence of renal deterioration with 1-hour pamidronate infusions from a population database was compared to renal deterioration with 2-hour pamidronate infusions, in randomised, controlled, trials. A cost-minimisation analysis, comparing the 1-and 2-hour pamidronate infusions, and the 15-minute infusion of zoledronic acid, was performed with a sensitivity analysis that varied the opportunity cost of time in the treatment room.

Results. Renal deterioration occurred in 7.7% of 169 patients with multiple myeloma and metastatic breast cancer. There is no evidence that this differs from the 10% reported in randomised, controlled, trials (one-tailed binomial test, P=0.3874). A subgroup analysis showed that renal deterioration occurred in 15 and 1.1% of patients with multiple myeloma and metastatic breast cancer, respectively. The median increase in serum creatinine was 13 and 7% in the multiple myeloma and breast cancer groups, respectively. The respective costs/dose (drug/ labour/supplies) of pamidronate and zoledronic acid are $325 and $610. Cost neutrality occurs if the opportunity cost of chair time is $6.33/ minute for pamidronate 1-hour versus zoledronic acid, and $2.71/minute for pamidronate 2-hour versus zoledronic acid. If a median $4/minute is used, the respective costs of pamidronate 1-hour, 2-hour, and zoledronic acid infusions are $685, $925, and $790/cycle.

Conclusions. Prevalence of renal deterioration with 1-hour pamidronate infusions from a population database was not significantly different to 2-hour pamidronate infusions in clinical trials. Our findings suggest further support for the safety of 1-hour pamidronate infusions. Pamidronate via 1-hour infusion is less expensive than zoledronic acid.

Key Words: biphosphonates • breast cancer • multiple myeloma • pamidronate • renal toxicity

Journal of Oncology Pharmacy Practice, Vol. 12, No. 4, 193-199 (2006)
DOI: 10.1177/1078155206073520


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