Zometa

Is Zometa and Aredia the same thing? Is one better than the other?

Zometa and Aredia are two different drugs from bisphosphonates group. The effectiveness is almost the same (Zometa might be just a bit more effective). Both are given through IV, but Aredia is given during 2-2.5 hours while Zometa - 15-30 minutes (according to some studies, 30 minutes IV tends to provoke less SE).

Ladies, I have a question along the same lines.  I will be starting zometa as a precaution for osteoporosis (really for risk of recurrence, but this is the angle my onc has to take to get it approved) and was wondering when I should do all my dental work.  I was pregnant before all this breast cancer crap, so I haven't had any dental exams/ work since before that.  I know I'm due for major teeth cleaning and probably a few other minor things.  Do I go for the exam now since I'm a month out from chemo and before I start the zometa?  Or do I need to wait longer from the end of chemo?  Also, I am to start radiation in 2 weeks.  Do they wait to do the zometa after that?  Can I get the dental work done during rads?

Moissy, I think you are right--I've read that the half-life (the amount of time it stays in your body) is extremely long (years!)  That is also the reason they think the benefit of even a short time on zometa lasts several years.

SABCS 2008: Zoledronic Acid Has Direct Effect on Breast Cancer

Zosia Chustecka

December 12, 2008 (San Antonio, Texas) - New data suggest that zoledronic acid (Zometa, Novartis) has a direct effect on breast cancer. The bisphosphonate is currently marketed for osteoporosis and bone metastasis, but there is growing evidence to suggest that it might also have a role to play in breast cancer.

Preliminary results from a clinical-trial subset presented here at the 31st Annual San Antonio Breast Cancer Symposium show that when zoledronic acid was used with chemotherapy in the neoadjuvant setting, the combination led to a significantly greater shrinkage of the primary tumor than was seen with chemotherapy alone.

Together with chemotherapy, you get this exquisite synergy.

Also, data from molecular studies presented here show that the combination produces a change in the expression of a number of genes and proteins associated with cell-cycle regulation and apoptosis, but neither produced these changes when used alone. "Zoledronic acid on its own had no appreciable effect, but together with chemotherapy, you get this exquisite synergy," commented coauthor Robert Coleman, MD, FRCP, professor of medical oncology at the University of Sheffield, United Kingdom.

These new results are the second time this year that zoledronic acid has shown an effect on breast cancer. When added to adjuvant chemotherapy, it significantly reduced the relapse rate in early breast cancer in the Austrian Breast and Colorectal Cancer Study Group trial 12. These results were presented at this year's American Society of Clinical Oncology meeting, and reported by Medscape Oncology at that time.

Neoadjuvant Use Increased Tumor Shrinkage

The latest data come from the AZURE (Neo-Adjuvant Zoledronic Acid to Reduce Recurrence) trial, conducted in 3360 patients with stage 2 or 3 breast cancer. Patients received standard neoadjuvant chemotherapy with or without the addition of zoledronic acid before surgery, and then standard adjuvant chemotherapy with or without zoledronic acid after surgery. The study was funded by the manufacturer.

The overall results of this trial are still being evaluated, but at the San Antonio meeting, Dr. Coleman presented preliminary results for a subgroup of 205 patients for whom a retrospective pathology analysis had been performed.

The results from this subgroup suggest that the addition of zoledronic acid leads to a greater shrinkage of the primary tumor. After surgery, the median residual tumor size was significantly smaller in women receiving both chemotherapy and zoledronic acid (20.5 mm vs 30.0 mm) than in those receiving chemotherapy alone (P = .002). In addition, a complete pathologic response was seen in 10.8% of women in the combination group vs 5.8% of those in the chemotherapy-alone group (P = .02).

Fewer Women Had a Mastectomy

In this neoadjuvant setting, the goal is to reduce the size of the tumor, and in doing so to potentially improve breast conservation rates and longer-term outcomes, explained coauthor Matthew Winter, MBChB, MSc, clinical research fellow at the University of Sheffield. In this analysis, fewer women in the combination group required a mastectomy (65.3% compared with 77.9% in the chemotherapy-alone group).

"The results support a potential antitumor benefit of combining zoledronic acid with chemotherapy in the neoadjuvant treatment of breast cancer," Dr. Winter commented in a statement.

Dr. Coleman emphasized that these results come from a retrospective and exploratory analysis and, hence, they should be regarded as hypothesis generating. But if the results from the overall AZURE trial confirm these findings, they could be practice changing, he suggested.

The final results from AZURE are expected in the next 2 or 3years, according to a Novartis spokesperson, who said Novartis is "committed to further exploring zoledronic acid as an anticancer treatment."

Less Bone Loss

Another presentation at the meeting reported an effect of zoledronic acid on breast cancer in yet another setting. ZO-FAST (Zometa-Femara Adjuvant Synergy Trial) assessed the effect of zoledronic acid on bone loss associated with the aromatase inhibitor letrozole in postmenopausal women with early breast cancer. The interim results at 36 months, assessed by bone-mineral-density measurements, show that the bisphosphonate is effective in preventing this bone loss, reported lead researcher Holger Eidtmann, MD, from University Frauenklinik, in Kiel, Germany.

However, the results also show an effect on breast cancer, he noted. In this study, one group of patients took zoledronic acid throughout the study (the immediate-zoledronic-acid group), and the other group took the drug only if bone-mineral density fell or they had a fracture (the delayed-zoledronic-acid group). The immediate group had a significantly lower disease recurrence than the delayed group (22 events vs 37 events; P = .0423), he reported.

When asked whether he would recommend zoledronic acid for breast cancer patients who are at increased risk for relapse, Dr. Eidtmann said: "No, I think it is too early for that; these results are only 3-year follow-up [data]. But I do believe that there is antitumor activity of zoledronic acid in breast cancer."

AZURE and ZO-FAST were funded by Novartis. Dr. Coleman reported serving on the speakers' bureau for Novartis. Dr. Eidtmann has disclosed no relevant financial relationships.

31st Annual San Antonio Breast Cancer Symposium (SABCS): Abstracts 2151, 5101, and 44. Presented December 12 and 13, 2008

Sherri - my Onc seemed to think it would be only beneficial if used adjunctively (sp??) Anyhow, right after active treatment. My feeling from her was that if I waited until the major studies were finished, it would be too late for me to get benefit.

Also your point about having it "in the wings" is something I have thought about too. 

That being said, i am happy with my decision to take it. The way I see it, everything we have done has the potential for major SE's. I just wish they

btw-I am fighting for Zometa during chemo-she has agreed to do it with my first chemo session but I haven't sprung this study on her yet and it's dosing schedule-but I want it given to me this route.

Jen said "I will take lock jaw if it means saving my life" Couldn't agree more.

I'm all set to go.  My first infusion is next Friday and I couldn't be happier.

Hi

I had my first Zometa because my BMD has dropped to oseoporosis following 2 years of Tam and 1 year of Femara.  My bone and muscle pains have improved drastically since, I had very tolerable SEs.  My next shot is in Feb, when i get my BMD measurments i will let you know ( I am 50 years old and my BMD is as bad as my mother).

HH

Hi

I started zometa 3 years after chemo . 3 years of  hormanal therapy has caused a large drop in my bone density. 

You have to get rads. if you are not doing a mastactomy..

OK, guys, here's more info to ponder. I had my first "real" followup appt. with my new onc, who I now officially love. He didn't care how long my list of questions was as opposed to my original onc who always felt challenged anytime I asked a question. New onc was part of the ZFast/Zofast Zometa trial and had previously told me on a consultation when I was considering switching to him that I was a "perfect candidate" for Zometa because I also have osteopenia.

After reading about the fact that at '09 San Antonio conference they reported that Fosamax may reduce chance of getting bc in first place...I started wondering since I have been taking Fosamax for 5 years with my Arimidex if that may have been protecting me. I also was reading about how the longer you're on bisphosphonates the higher risk you have for ONJ. Started worrying whether my 5-year Fosamax history plus IV Zometa might put me in higher risk and wondering whether worth it. 

He thinks eventually they may find that all the bisphosphonates help reduce bc. So he felt it was fine for me to just stay on the Fosamax. If I were just entering treatment, I would personally definitely go for Zometa since it's proven synergistic with chemo. But since I have already had a lot of Fosamax, I've decided to hang tight for now.

Lexis beat me to it.  In one of the Austrian studies, they treated pre-menopausal women with goserilin, a drug that puts them into chemical menopause, and treated half with zometa.  In both the zometa group and the non-zometa group, they treated half with tamoxifen and half with an aromatase inhibitor.  All of the women on zometa received the same benefit of reduced recurrance, regardless of whether they were on tamoxifen or AI.

Not sure as to what the time line is as to when you can start taking Zometa or when you can't.  I'm 7 months post-chemo, and I'm really happy that my onc approved it.  I have been after him since July about it and to tell you the truth, I was on the verge of getting a new onc if he didn't approve it at my last appt. 

I just received my delivery today - going on Friday for my first infusion. 

P.S.  Was I suppose to tip the "delivery guy"???!!! 

Yeah, that's still my question.  When can you start taking zometa--after or during rads?