SUMMARY. INTRODUCTION: Bone metastases occur in 20% to 40% of patients with lung cancer. Recent studies (most in vitro) demonstrate an anti-proliferative effect of third-generation biphosphonates (BPs) on lung tumours which may, indirectly, have an impact on the survival. OBJECTIVES: This was a study of the effects of treatment with BPs on the course and survival of lung cancer patients with bone metastases. PATIENTS AND METHODS: For the study 108 male patients with lung cancer (stage IV) were recruited consecutively. Of these, 55/108 patients with positive bone scan experienced bone pain and received Nitrogen BPs (NBPs), specifically zoledronic acid (ZOL), 4 mg i.v. every 21 days (Group A). The other 53 patients received no NBPs, of which 30/53 had a positive bone scan (Group B) and 23/53 a negative bone scan (Group C). All patients were treated with combination chemotherapy consisting of Docitaxel 100 mg/m2 and Carboplatin AUC = 6. RESULTS: Group A had a statistically significantly longer mean survival and time to progression than Groups B and C (p<0.001). A statistically significant positive correlation was found between the number of cycles of therapy with NBPs and total patient survival (p<0.01, Pearson Correlation) and time to progression (p<0.01). Regarding the pain effect in relation to baseline, no significant difference was observed between the two groups of patients (with and without NBPs) with positive bone scan (p>0.05). CONCLUSION: The addition of NBPs to the treatment regime appears to increase overall survival in lung cancer patients with bone metastases. Further studies are needed to support the potential usefulness of NBPs as an independent therapeutic agent against lung cancer. Pneumon 2009; 22(1):–