After Radiotherapy, Do Bone Metastases from Gastrointestinal Cancers Show Response Rates Similar to Those of Bone Metastases from Other Primary Cancers?

Abstract

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 because of pain and skeletal related events (sres). Bisphosphonates are potent inhibitors of osteoclastic function and the mainstay of bone-directed therapy for bone metastases. The aims of bisphosphonates are to prevent and delay sres, to reduce bone pain, and to improve quality of life. Bisphosphonate therapy appears to have revolutionized treatment of bone metastases, but bisphosphonate use has several limitations. Those limitations include the high cost of the agents and the need for return trips to the clinic for intravenous treatment. Moreover, many uncertainties surround bisphosphonate use—for example, the timing of bisphosphonate initiation, the choice of bisphosphonate to use, the optimal duration of treatment, and the appropriate means to identify patients who will and will not benefit. In addition, potentially serious adverse effects have been associated with bisphosphonate use—for example, renal toxicity, gastrointestinal side effects, and osteonecrosis of the jaw. The present review is intended as a primer for oncology specialists who treat patients with bone metastases secondary to breast cancer. It focuses on bisphosphonate treatment guidelines, the evidence for those guidelines, and a discussion of new therapeutic agents. It also discusses the use of biochemical markers of bone metabolism, which show promise for predicting the risk of a patient’s developing a sre and of benefiting from bisphosphonate treatment.

Imaging features of bone metastases in patient with gastrointestinal stromal tumors

“…Depending on the nature of the imminent or actual skeletal complication, a wide variety of treatment options are available to treat bone metastases, including systemic treatment with bisphosphonates, radiation therapy, ablation, vertebroplasty, and surgery (15). Bisphosphonates are potent inhibitors of osteoclast-mediated bone resorption and reduce skeletal complications and provide some pain relief (15).…”

“…Bisphosphonates are potent inhibitors of osteoclast-mediated bone resorption and reduce skeletal complications and provide some pain relief (15).…”

Metastatic Bone Disease in Patients with Solid Tumors–-Burden of Bone Disease and the Role of Zoledronic Acid

“…49,50 The orally administered bisphosphonates clodronate and ibandronate have shown some effi cacy in preventing SREs in patients with breast cancer. 51 For these agents, the apparent convenience of oral administration is undermined by the need to follow a strict dosing regimen that requires fasting before ingesting the drug and remaining upright for a specifi ed duration afterward. Compliance with dosing regimens for oral bisphosphonates is poor overall, 52 and these regimens may be especially challenging for patients with thoracic tumors that may constrict the esophagus.…”

Clinical significance of interleukin (IL)-6 in cancer metastasis to bone: potential of anti-IL-6 therapies

“…24,118,119 The humanized monoclonal antibody to the IL-6 receptor, tocilizumab (Actemra ® ) was approved by the United States Food and Drug Administration (FDA) on January 11, 2010 and was previously approved in Japan and the European Medicines Agency (EMEA) in 2008 (Table 1). 120 Although tocilizumab is approved only for rheumatoid arthritis (RA) in the United States and Europe as well as Castleman's disease in Japan, recent studies have shown that tocilizumab is also effective as an antitumor agent against U87MG glioma cells.…”