Zometa with Chemo Before Surgery Helps Kill Breast Cancer Cells in Bone Marrow

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Zometa (chemical name: zoledronic acid) is a medicine used to strengthen bones in women diagnosed with breast cancer that has spread to the bone. Zometa can reduce bone pain and the risk of broken bones.

A small study found that adding Zometa to chemotherapy given before early-stage breast cancer surgery may destroy breast cancer cells that have traveled to the bone marrow in some women. Chemotherapy given before surgery is called neoadjuvant chemotherapy. The results of this study confirm results from other small studies suggesting that Zometa may help treat breast cancer, rather than just improving bone health in women with breast cancer that has spread to the bone. Research in the lab also suggests that Zometa can weaken or destroy breast cancer cells.

In this study, 109 women diagnosed with stage II or stage III breast cancer were treated with the chemotherapy medicines Ellence (chemical name: epirubicin) and Taxotere (chemical name: docetaxel) before surgery. About half the women also randomly got Zometa, while the other half got a placebo.

Before treatment started, all of the women had a bone marrow sample taken to see if breast cancer cells had traveled there:

  • 26 of 60 women (43%) who were to get both chemotherapy and Zometa before surgery had breast cancer cells in their bone marrow
  • 28 of 58 women (48%) who were to get chemotherapy and the placebo before surgery had breast cancer cells in their bone marrow

Three months after chemotherapy treatment, all the women had another bone marrow test:

  • 17 of 56 women (30%) who got chemotherapy and Zometa before surgery had breast cancer cells in their bone marrow, compared to 43% before chemotherapy and Zometa treatment
  • 25 of 53 women (47%) who got chemotherapy and placebo before surgery had breast cancer cells in their bone marrow, compared to 48% before chemotherapy and placebo

So it seems that adding Zometa to chemotherapy before surgery lowered the likelihood of finding breast cancer cells in bone marrow 3 months later. Still, it's important to know that this lower likelihood wasn't statistically significant, which means it could have been due to chance and not because Zometa was added to the chemotherapy.

The researchers studied women who didn't have cancer cells in their bone marrow before treatment as a separate group:

  • 27 of 31 women (87%) still didn't have cancer cells in their bone marrow 3 months after chemotherapy and Zometa before surgery
  • 15 of 31 women (60%) still didn't have cancer cells in their bone marrow 3 months after chemotherapy and placebo before surgery

So adding Zometa to chemotherapy before surgery seemed to reduce the risk of finding breast cancer cells in bone marrow 3 months later for women who didn't have cancer cells in bone marrow when diagnosed. This reduction in risk was statistically significant, which means it was probably because of the Zometa and not due to chance.

Zometa didn't seem to affect the risk of the breast cancer coming back (recurrence), survival without the breast cancer coming back, and overall survival (whether or not the breast cancer came back) 1 and 2 years after diagnosis.

As expected, the researchers found that women who got Zometa had better bone health 1 year after treatment.

A second small study looked to see if Zometa could treat breast cancer effectively, but the results didn't show any benefits.

A treatment that fights breast cancer AND helps keep bones strong during treatment would be a good thing. But more research is needed so doctors can understand if and how Zometa can be used to treat breast cancer. In the meantime, Zometa will still be used to strengthen bones in women diagnosed with breast cancer that has spread to the bones. Studies like the one reviewed here may not offer immediate advances, but offer promise for future treatments.

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