Elsevier

Cancer Treatment Reviews

Volume 31, Issue 4, June 2005, Pages 303-311
Cancer Treatment Reviews

COMPLICATIONS OF TREATMENT
Approaches to managing bone metastases from breast cancer: The role of bisphosphonates

https://doi.org/10.1016/j.ctrv.2005.03.005 Get rights and content

Summary

Conventional management of metastatic bone disease involves local and systemic therapies in various combinations, along with symptomatic management to provide optimal care. In recent years, it has become clear that adding bisphosphonates to these treatments reduces the incidence and severity of skeletal complications. Bisphosphonates can also relieve metastatic bone pain and improve quality of life, although the extent to which they have demonstrated these effects may differ between agents.

While bisphosphonates are the standard of care for the treatment of bone metastases, clinical trials are investigating additional indications for these agents, including the use of intensive dosing regimens for the relief of severe or opioid-resistant metastatic bone pain and adjuvant treatment for the prevention of bone metastases and cancer treatment-induced bone loss. Current and future indications demand effective, well-tolerated and convenient bisphosphonates, and the benefits of different drugs must be balanced against their limitations. The cost-effectiveness of bisphosphonate treatment is also a consideration, given the high economic burden of metastatic bone disease from breast cancer.

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

Section snippets

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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