Renal safety with pamidronate (PAM) 1-hour infusion for metastatic breast cancer (MBC) and multiple myeloma (MM): A multi-centre, population-based analysis
Bibliographic record
Abstract
6042 Background: ASCO guidelines recommend PAM be infused over 2 hours to avoid renal deterioration (RD). BCCA recommends 1-hr PAM infusions based on safety from two case series, one randomized controlled trial (RCT) (ASCO 1999 abstract 2223) and one retrospective analysis (ASCO 2002 abstract 208). Longer PAM infusions can affect the optimal use of healthcare resources. Methods: Prevalence of RD (≥ 2 times baseline serum creatinine [SCr)]) with 1-hr PAM infusions between Jan 2000-Dec 2002 from the BCCA registry and systemic therapy drug database was compared to that with 2-hr PAM infusions in RCTs. A cost-minimization analysis comparing the 1- and 2-hr PAM infusions and the 15-minute infusion of zoledronic acid (ZA) was performed with a sensitivity analysis that varied the opportunity cost of time in the treatment room. Results: RD occurred in 10.4% of 144 patients: 15.5% (13/87) in MM, 3.5% (2/57) in MBC. There is no evidence that this differs from the 10% reported in RCTs (one-tailed binomial test, p=0.4741). Increase in SCr was not normally distributed: median increase = 14% in MM and 13% in MBC patients, respectively. The respective costs/dose (drug/labour/supplies) of PAM and ZA are $325 and $610CDN. Cost neutrality occurs if the opportunity cost of chair time is $6.33/min for PAM 1-hr vs ZA and $2.71/min for PAM 2-hr vs ZA. If a median $4/min is used, the respective costs of PAM 1-hr, 2-hr, and ZA infusions become: $685, $790, and $925. Conclusions: Prevalence of RD with 1-hr PAM infusions from a population database was not different than that with 2-hr PAM infusions in RCTs. Our findings further support the safety of 1-hr PAM infusions. PAM via 1-hr infusion is less expensive than ZA. No significant financial relationships to disclose.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.019 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.007 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".