A Primer of Bone Metastases Management in Breast Cancer Patients

Mark Clemons, Bianca Petrut, Mateya Trinkaus, Christine Simmons


Bone is the most common site for distant spread of breast cancer. Following a diagnosis of metastatic bone disease patients can suffer from significant morbidity due to pain and skeletal related events (SREs). Bisphosphonates (BPs) are potent inhibitors of osteoclastic function and are the mainstay of bone-directed therapy for bone metastases. The aims of BPs are to prevent and delay SREs, reduce bone pain and improve quality of life. While BP therapy appears to have revolutionized treatment of bone metastases (BM), there are several limitations to BP use. These include the high cost of these agents and the need for return trips to the clinic for intravenous treatment. Moreover, there exist many uncertainties regarding BP use such as when to start BP treatment, which BP to use, the optimal duration of treatment, as well as appropriately identifying patients who would actually benefit from BP use and those that will not benefit from BP use. In addition to these concerns, there are potentially serious adverse effects such as renal toxicity, gastrointestinal side effects, and osteonecrosis of the jaw. This review is intended to be a primer for oncology specialists who treat patients with bone metastases secondary to breast cancer with a focus on BP treatment guidelines, the evidence for these guidelines, and a discussion of new therapeutic agents. It will also discuss the use of biochemical markers of bone metabolism, which show promise for predicting patient risk of developing an SRE and of benefiting from BP treatment.

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DOI: http://dx.doi.org/10.3747/co.v15i0.205

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ISSN: 1198-0052 (Print) ISSN: 1718-7729 (Online)