Purpose: Bone metastases have a considerable impact on quality of life in patients with breast and other cancers. Tumors produce osteoclast-activating factors, whereas bone resorption promotes the growth of tumor cells, thus leading to a "vicious cycle" of bone metastasis. Sagopilone, a novel, fully synthetic epothilone, inhibits the growth of breast cancer cells in vitro and in vivo, and here we report its activity in the MDA-MB-231(SA) breast cancer bone metastasis mouse model. Experimental Design: The potency of sagopilone was determined in treatment models simulating the adjuvant (preventive) and metastatic (therapeutic) settings in the clinic. Results: We showed that sagopilone inhibited tumor burden and bone destruction, in addition to reducing tumor-induced cachexia and paraplegia. The reduction in osteolytic lesions, tumor growth in bone, and weight loss was statistically significant in the preventive model compared with the vehicle group. In the therapeutic model, sagopilone treatment significantly lowered the number of activated osteoclasts and significantly reduced the osteolytic lesion area, bone volume loss, and bone resorption compared with vehicle treatment while simultaneously inhibiting tumor burden. An in vitro assay confirmed that sagopilone inhibited osteoclast activation without cytotoxic effects, whereas paclitaxel resulted in lower inhibition and high levels of cytotoxicity. Conclusions: Sagopilone seems to inhibit the vicious cycle at both the tumor growth and bone resorption stages, suggesting the possibility for substantial benefit in the treatment of patients with breast cancer at risk from bone metastases or with bone lesions already present. Phase II clinical trials with sagopilone in patients with breast cancer are ongoing.Bone is the most common site for a distant metastasis in women with breast cancer (1), with a reported incidence of up to 75% (2, 3) and an average survival time of ∼2 years after diagnosis (3). Symptoms of bone metastases include skeletal complications and bone pain, which affects up to 80% of patients and greatly impacts on their quality of life (4).Primary breast tumors express osteolytic and osteoblastic factors, stimulating different types of bone metastases, with osteolytic lesions occurring more commonly (5, 6). The development of osteolytic bone metastases has been described as a vicious cycle, with increased osteoclast activity implicated as the predominant mechanism of bone destruction (6). Tumor cells produce factors, such as parathyroid hormone-related protein, which are responsible for an increase of osteoclast activity and consequent bone resorption. Growth factors stored in bone and released during bone resorption in turn stimulate tumor cell growth, thus perpetuating the vicious cycle. The quality of life of breast cancer patients could be considerably increased by a potent inhibitor of bone metastasis (7), and a drug that could simultaneously and effectively inhibit both tumor cell growth and osteoclast activity would have great potential...