[From laundry product to cancer drug--history of a drug class].

BACKGROUND

In recent years, the management of tumor-induced bone lesions has been fundamentally changed by the therapeutic class of the bisphosphonates. TUMOR-INDUCED HYPERCALCEMIA (TIH): This was the first oncological entity to be treated with bisphosphonates. Because of the impaired renal function that always accompanies TIH, bisphosphonates must be infused sufficiently diluted and over a period of 2 to 4 h in this indication. The success rate (normalisation of serum calcium levels) with pamidronate is > 90%. TUMOR-INDUCED OSTEOLYSIS (TIO): Intravenously administered bisphosphonates like pamidronate do not only significantly reduce the rate of complications from TIO, both in breast cancer and multiple myeloma, but they also frequently lead to a remission in bone (sclerosis of the lesion). For the modern amino-bisphosphonates a direct anti-tumoral effect could be shown, too.

NEW DEVELOPMENTS: New bisphosphonates of the 3rd generation are under development. Zoledronat, a new chemical entity from Novartis, is currently the most potent bisphosphonate. Clinical studies have shown that zoledronate is significantly more effective than pamidronate in the treatment of HCM.

CONCLUSION

Bisphosphonates are today an important part of the standard therapy of tumor-induced bone diseases. Due to their direct anti-tumoral effects, the modern drugs of this class play an increasing role also in the prevention of bone metastases.