Bisphosphonates in Clinical Oncology

The book gives an overview of the clinical developments in the use of bisphosphonates in clinical oncology. The first part pre­ sents the composition, physiology, and pathophysiology of bone. Next is a section giving insight into mechanisms of bone resorp­ tion, bone formation, and bone remodeling, a field in which I was most influenced by O. L. M. Bijvoet and H. Fleisch. The sec­ ond part summarizes the pharmacological treatments for disor­ ders of bone remodeling. The clinical aspects of tumor-induced hypercalcemia and its management are described in detail, in­ cluding our first prospective randomized crossover study testing pamidronate versus mithramycin. The bisphosphonates were in­ troduced in clinical oncology by endocrinologists. The same was true for our institution in 1986, when P. Burckhardt proposed testing pamidronate in the above-mentioned trial in his institu­ tion (CHUV) and in our department. The impressive results ob­ tained in the hypercalcemia trial stimulated our interest, and we actively investigated the use of pamidronate to counteract osteo­ lytic bone destruction in cancer patients. These investigations are presented and discussed in the third part. They represent the interdisciplinary work involving many co-workers of the Depart­ ment of Internal Medicine C and other institutes of the Interdis­ ciplinary Oncology Center St. Gallen (IOSG), which I was privi­ leged to chair for 10 years. Initially, a pharmacokinetic study was performed in order to optimize and facilitate the administration of the drug to patients with malignant osteolytic bone disease.