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Bisphosphonates and risk of lung cancer: Protocol for a systematic review and meta-analysis.

ABSTRACT:

Abstract

The association between the use of bisphosphonates (BPs) and the risk of lung cancer has been concerned recently. There is no explicit study indicating that whether the use of BPs would affect the risk of lung cancer. So, we conducted a meta-analysis to figure out the relationship between BPs and lung cancer.We searched the databases of PubMed and Embase. The random effects were used to calculate the pooled odds ratios (ORs) and 95% confidence interval (CIs) for the risk of lung cancer in BPs users compared with non-users. The stability of our results was evaluated by the sensitivity analysis. The publication bias was assessed in our study. The data in our study comes from the public database, therefore ethical approval is not necessary. Also, our study did not involve patient consent.Four studies met our inclusion criteria. All the included studies are cohort studies. Our analysis indicated that there was no significant association between the use of BPs and the risk of lung cancer (OR 1.02, 95%CI 0.85- 1.24, I2 71%). In our secondary analysis, the use of alendronate may increase the risk of lung cancer. The pooled OR of 3 studies is (OR 1.10, 95%CI 0.84-1.45, I2 77%), but when we performed a sensitivity analysis, 1 of the OR is (OR 1.23, 95%CI 1.02-1.49, I2 4.1%).This is the most detailed meta-analysis on this topic. And there was no significant association between the use of BPs and lung cancer. However, exposure to alendronate may increase the risk of lung cancer. More studies are needed to confirm our findings.

SUBMITTER: Li M

PROVIDER: S-EPMC7793382 | biostudies-literature | 2021 Jan

REPOSITORIES: biostudies-literature

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Bisphosphonates and risk of lung cancer: Protocol for a systematic review and meta-analysis.

Li Minghao M Li Minghao M Zhong Muyan M Guan Chengnong C

Medicine 20210101 1

<h4>Abstract</h4>The association between the use of bisphosphonates (BPs) and the risk of lung cancer has been concerned recently. There is no explicit study indicating that whether the use of BPs would affect the risk of lung cancer. So, we conducted a meta-analysis to figure out the relationship between BPs and lung cancer.We searched the databases of PubMed and Embase. The random effects were used to calculate the pooled odds ratios (ORs) and 95% confidence interval (CIs) for the risk of lung ...[more]

PMID: 33429726

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Project description:BackgroundBisphosphonate drugs can be used to improve the outcomes of women with breast cancer. Whilst many meta-analyses have quantified their potential benefits for patients, attempts at comprehensive quantification of potential adverse effects have been limited. We undertook a meta-analysis with novel methodology to identify and quantify these adverse effects.MethodsWe systematically reviewed randomised controlled trials in breast cancer where at least one of the treatments was a bisphosphonate (zoledronic acid, ibandronate, pamidronate, alendronate or clodronate). Neoadjuvant, adjuvant and metastatic settings were examined. Primary outcomes were adverse events of any type or severity (excluding death). We carried out pairwise and network meta-analyses to estimate the size of any adverse effects potentially related to bisphosphonates. In order to ascertain whether adverse effects differed by individual factors such as age, or interacted with other common adjuvant breast cancer treatments, we examined individual-level patient data for one large trial, AZURE.FindingsWe identified 56 trials that reported adverse data, which included a total of 29,248 patients (18,301 receiving bisphosphonate drugs versus 10,947 not). 24 out of the 103 different adverse outcomes analysed showed a statistically and practically significant increase in patients receiving a bisphosphonate drug compared with those not (2 additional outcomes that appeared statistically significant came only from small studies with low event counts and no clinical suspicion so are likely artifacts). Most of these 24 are already clinically recognised: 'flu-like symptoms, fever, headache and chills; increased bone pain, arthralgia, myalgia, back pain; cardiac events, thromboembolic events; hypocalcaemia and osteonecrosis of the jaw; as well as possibly stiffness and nausea. Oral clodronate appeared to increase the risk of vomiting and diarrhoea (which may also be increased by other bisphosphonates), and there may be some hepatotoxicity. Four additional potential adverse effects emerged for bisphosphonate drugs in this analysis which have not classically be recognised: fatigue, neurosensory problems, hypertonia/muscle spasms and possibly dysgeusia. Several symptoms previously reported as potential side effects in the literature were not significantly increased in this analysis: constipation, insomnia, respiratory problems, oedema or thirst/dry mouth. Individual patient-level data and subgroup analysis revealed little variation in side effects between women of different ages or menopausal status, those with metastatic versus non-metastatic cancer, or between women receiving different concurrent breast cancer therapies.ConclusionsThis meta-analysis has produced estimates for the absolute frequencies of a range of side effects significantly associated with bisphosphonate drugs when used by breast cancer patients. These results show good agreement with previous literature on the subject but are the first systematic quantification of side effects and their severities. However, the analysis is limited by the availability and quality of data on adverse events, and the potential for bias introduced by a lack of standards for reporting of such events. We therefore present a table of adverse effects for bisphosphonates, identified and quantified to the best of our ability from a large number of trials, which we hope can be used to improve the communication of the potential harms of these drugs to patients and their healthcare providers.

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Bisphosphonates and risk of lung cancer: Protocol for a systematic review and meta-analysis.

Abstract

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Bisphosphonates and risk of lung cancer: Protocol for a systematic review and meta-analysis.

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