COMPLICATIONS OF TREATMENT
Approaches to managing bone metastases from breast cancer: The role of bisphosphonates
Introduction
Bone is the most common site of metastatic disease in patients with breast cancer.1 Metastatic bone disease causes substantial morbidity, leading to major skeletal events such as fracture, hypercalcaemia, or spinal cord compression.[2], [3], [4], [5], [6] Bone pain is also a common and frustrating complication of metastatic bone disease.[4], [5], [6] Together, skeletal events and bone pain can have far-reaching effects on a patient’s quality of life.
Metastatic bone disease develops as a result of interactions between tumour cells and bone cells.[4], [5] Tumour cells in the bone-marrow cavity disrupt the normal interactions between osteoclasts (responsible for bone resorption) and osteoblasts (promote synthesis of new bone). This results in uncoupling of bone remodeling, and an imbalance between bone destruction and new bone formation. Bone metastases from breast cancer are predominantly osteolytic (i.e., they are linked to increased osteoclastic activity).5
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Approaches to the management of bone metastases
Therapeutic goals in metastatic bone disease are to prevent bone events, relieve pain, and improve quality of life without adding to the treatment burden of patients with advanced cancer. Conventional management involves local (e.g., radiation therapy, surgery) and systemic (e.g., chemotherapy, hormone therapy) therapies in various combinations, along with symptomatic management (e.g., analgesics) to provide optimal care. In recent years, it has become clear that adding bisphosphonates to these
Conclusions
Bisphosphonates are an important component of treatment for metastatic bone disease from breast cancer. Used alongside other therapies, they can prevent SREs and improve quality of life. Bisphosphonates also relieve metastatic bone pain – this is particularly relevant as bone pain is often under-treated in cancer patients.[67], [68] In addition to efficacy, the choice of bisphosphonate for bone metastases from breast cancer is also influenced by safety, convenience and cost-effectiveness.
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Adjuvant Analgesics
2007, Anesthesiology ClinicsCitation Excerpt :Earlier bisphosphonates, such as etidronate, have been largely replaced by the use of second-generation bisphosphonates, including pamidronate, as well as third-generation bisphosphonates, including zolendronic acid and ibandronate. Multiple studies have demonstrated the efficacy of second- and third-generation bisphosphonates in pain reduction for bone metastases [61–64]. Zolendronic acid and ibandronate provide significant and sustained relief from metastatic bone pain, improving patient functioning and quality of life.
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Combination ibandronate and radiotherapy for the treatment of bone metastases: Clinical evaluation and radiologic assessment
2007, International Journal of Radiation Oncology Biology PhysicsCitation Excerpt :Because radiotherapy suppresses urinary markers of bone resorption (7), its analgesic effects may also be mediated through direct osteoclast inhibition. Bisphosphonates have become a standard treatment for metastatic bone disease in recent years (2, 8, 9). These agents potently inhibit the excessive bone resorption caused by tumor growth.
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Adjuvant Analgesics
2007, Medical Clinics of North AmericaCitation Excerpt :Earlier bisphosphonates, such as etidronate, have been largely replaced by the use of second-generation bisphosphonates, including pamidronate, as well as third-generation bisphosphonates, including zolendronic acid and ibandronate. Multiple studies have demonstrated the efficacy of second- and third-generation bisphosphonates in pain reduction for bone metastases [61–64]. Zolendronic acid and ibandronate provide significant and sustained relief from metastatic bone pain, improving patient functioning and quality of life.
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Recycling the purpose of old drugs to treat ovarian cancer
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