Zoledronic acid (Zometa)

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General information

Class/mechanism: Bisphosphonate, inhibits osteoclast activity and bone resorption/turnover, induces osteoclast apoptosis, and inhibits skeletal calcium release by tumor stimulatory factors.[1][2][3]
Route: IV
Extravasation: no information

For conciseness and simplicity, HemOnc.org currently will focus on treatment regimens and not list information such as: renal/hepatic dose adjustments, metabolism (including CYP450), excretion, monitoring parameters (although this will be considered for checklists), or manufacturer. Instead, for the most current information, please refer to your preferred pharmacopeias such as Micromedex, Lexicomp, UpToDate (courtesy of Lexicomp), or the prescribing information.[1]

Disease-specific information

For now this will be a gathering point for RCTs examining the use of this agent, which does not have clear antineoplastic properties; in the future this information may be moved to separate page(s).

Multiple myeloma

  • MRC Myeloma IX: Morgan GJ, Davies FE, Gregory WM, Cocks K, Bell SE, Szubert AJ, Navarro-Coy N, Drayson MT, Owen RG, Feyler S, Ashcroft AJ, Ross F, Byrne J, Roddie H, Rudin C, Cook G, Jackson GH, Child JA; National Cancer Research Institute Haematological Oncology Clinical Study Group. First-line treatment with zoledronic acid as compared with clodronic acid in multiple myeloma (MRC Myeloma IX): a randomised controlled trial. Lancet. 2010 Dec 11;376(9757):1989-99. Epub 2010 Dec 3. link to original article link to PMC article PubMed

Prostate cancer

  • Fizazi K, Carducci M, Smith M, Damião R, Brown J, Karsh L, Milecki P, Shore N, Rader M, Wang H, Jiang Q, Tadros S, Dansey R, Goessl C. Denosumab versus zoledronic acid for treatment of bone metastases in men with castration-resistant prostate cancer: a randomised, double-blind study. Lancet. 2011 Mar 5;377(9768):813-22. Epub 2011 Feb 25. link to original article link to PMC article PubMed

Dosing

  • CALGB 70604 results, published as abstract only, demonstrate non-inferiority of 3-month dosing vs. monthly dosing.[4]
  • OPTIMIZE-2 demonstrated non-inferiority between every 4 week and every 12 week dosing in metastatic breast cancer.[5]

Patient drug information

Management checklist

  • Basic metabolic panel (BMP) including creatinine and calcium, albumin (to calculate corrected calcium), phosphorus, vitamin D 25, bone density, calcium & vitamin D supplementation, dental exam/dental health

Also known as

  • Generic names: acido zoledronico, zoledronate
  • Brand names: Aclasta, Blaztere, Cytozol, Reclast, Servycal, Zobone, Zoldonat, Zomera, Zometa, Zyfoss

References

  1. 1.0 1.1 1.2 Zoledronic acid (Zometa) package insert
  2. Zoledronic acid (Zometa) package insert (locally hosted backup)
  3. Zometa manufacturer's site
  4. Himelstein, Andrew Louis, Qin, Rui, Novotny, Paul J., Seisler, Drew K., Khatcheressian, James L., Roberts, John D., Grubbs, Stephen S., O'Connor, Tracey, Weckstein, Douglas, Loprinzi, Charles L., Shapiro, Charles L. CALGB 70604 (Alliance): A randomized phase III study of standard dosing vs. longer interval dosing of zoledronic acid in metastatic cancer. J Clin Oncol (Meeting Abstracts) 2015 33: 9501 link to abstract
  5. Hortobagyi GN, Van Poznak C, Harker WG, Gradishar WJ, Chew H, Dakhil SR, Haley BB, Sauter N, Mohanlal R, Zheng M, Lipton A. Continued Treatment Effect of Zoledronic Acid Dosing Every 12 vs 4 Weeks in Women With Breast Cancer Metastatic to Bone: The OPTIMIZE-2 Randomized Clinical Trial. JAMA Oncol. 2017 Jul 1;3(7):906-912. link to original articlePubMed
  6. Zoledronic acid (Zometa) patient drug information (Chemocare)
  7. Zoledronic acid (Zometa) patient drug information (UpToDate)