American Society of Clinical Oncology clinical practice guidelines: the role of XXXX in @entity1582 .

@entity1 @entity171 @entity5279 @entity146 @entity174 @entity1582 @entity79 @entity4381 @entity19160
PURPOSE: To determine clinical practice guidelines for the use of @entity171 in the prevention and treatment of @entity79 in @entity1582 and to determine their respective role relative to other conventional therapies for this condition. METHODS: An expert multidisciplinary Panel reviewed pertinent information from the published literature through January 2002. Values for levels of evidence and grade of recommendation were assigned by expert reviewers and approved by the Panel. Expert consensus was used if there were insufficient published data. The Panel addressed which @entity1 to treat and when to treat them in the course of their disease. Additionally, specific drug delivery issues, duration of therapy, initiation of treatment and management of treatment of @entity79 was reviewed and compared with other forms of therapy for @entity79 . Finally, the Panel discussed @entity1 and physician expectations associated with this therapy for bony metastases, as well as public policy implications related to the use of @entity171 . The guidelines underwent external review by selected physicians, by the Health Services Research Committee members, and by the ASCO Board of Directors. RESULTS: The available evidence involving randomized controlled trials is modest but supports that oral @entity19160 , intravenous @entity5279 , and intravenous @entity4381 are superior to placebo in @entity146 . @entity174 has consistently been seen across all studies. No agent has shown a definitive survival benefit. Intravenous @entity4381 has recently been shown to be as effective as intravenous @entity5279 . Because there are no direct comparisons between @entity19160 and @entity5279 or @entity4381 , the superiority of one agent cannot be definitively established. However, the panel recommends only intravenous @entity5279 or @entity4381 in light of the use of the time to first skeletal event as the primary end point and more complete assessment of bony complications in studies evaluating it. Additionally, @entity19160 is not available in the United States. The choice between @entity5279 and @entity4381 will depend on choosing between the higher drug cost of @entity4381 , with its shorter, more convenient infusion time (15 minutes), versus the less expensive drug, @entity5279 , with its longer infusion time (2 hours). CONCLUSION: @entity171 provide a meaningful supportive benefit to @entity1582 @entity1 with @entity79 . However, further research on @entity171 is warranted, including the following: (1) when to start and stop therapy, (2) how to integrate their use with other treatments for @entity79 , (3) how to evaluate their role in @entity1582 @entity1 without lytic bone involvement, (4) how to distinguish between symptomatic and asymptomatic bony events, and (5) how to better determine their cost-benefit consequence.
