Less-Frequent Intravenous Zoledronic Acid for Patients with Skeletal Metastases

For patients with bone metastases from malignancies such as breast or prostate cancer or multiple myeloma, high-dose intravenous zoledronic acid (IV ZA; 4 mg every 4 weeks [Q4W]) lowers the incidence of skeletal-related events (SREs; e.g., clinical fracture). However, such therapy is associated with osteonecrosis of the jaw (ONJ) as well as the cost and inconvenience of monthly dosing. The Q4W dosing regimen was approved by the FDA based on empirical studies conducted before ONJ was recognized as a complication of IV ZA. Small studies have since suggested that less-frequent dosing may lower risk for ONJ (and annual treatment burden) without compromising zoledronic acid's effectiveness. Now, investigators randomized 1822 patients with bone m…