De Marinis, F., Eberhardt, W., Harper, P.G., Sureda, B.M., Nackaerts, K., Soerensen, J.B., . . . Tredaniel, J. (2009). Bisphosphonate use in patients with lung cancer and bone metastases: Recommendations of a European expert panel. Journal of Thoracic Oncology: Official Publication of the International Association for the Study of Lung Cancer, 4(10), 1280–1288.

To review current evidence regarding the use of bisphosphonates for the treatment of lung cancer and to provide European recommendations for practice

An expert panel of European clinical oncologists and lung cancer specialists reviewed available evidence regarding the use of bisphosphonates for the treatment of lung cancer and developed recommendations based on the evidence and clinical experience. The International Association for the Study of Lung Cancer published the resulting report. Authors did not provide specific search description, cite the process of review, or present evidence.

The report made the recommendations that follow.

• Initial staging of lung cancer should include assessment for bone metastases.
• In caring for patients with lung cancer with bone involvement, clinicians must consider bisphosphonate as a treatment. Such treatment will delay and prevent further bone metastases, help prevent skeleton-related events, and relieve pain.
• Clinicians should add bisphosphonates to the treatment of those who develop bone metastases.
• Comprehensive dental examination should precede treatment with bisphosphonates.
• Treatment with bisphosphonates should continue as long as feasible, in the absence of severe adverse effects.
• Bisphosphonate treatment, in combination with chemotherapy, is generally well tolerated and may produce synergistic effects.
• Zoledronic acid is recommended for the treatment of patients with lung cancer and bone metastases.

The International Association for the Study of Lung Cancer recommends the use of bisphosphonates in general and zoledronic acid in particular for patients, with all types of lung cancer, who have bone metastases. Nurses should be aware of potential adverse events of this treatment, though it is generally well tolerated. Because bisphosphonate treatment is associated with osteonecrosis, patients should have a comprehensive dental examination and prophylaxis before starting bisphosphonate treatment. Nurses should also be aware of the potential renal effects of bisphosphonate, especially on patients whose renal function has deteriorated as the result of other nephrotoxic drugs, dehydration, renal impairment, or lack of adherence to the recommended infusion schedule for bisphosphonate.