Medical Treatment of Breast Cancer Bone Metastasis: From Bisphosphonates to Targeted Drugs

Abstract

Breast cancer bone metastasis causing severe morbidity is commonly encountered in daily clinical practice. It causes pain, pathologic fractures, spinal cord and other nerve compression syndromes and life threatening hypercalcemia. Breast cancer metastasizes to bone through complicated steps in which numerous molecules play roles. Metastatic cells disrupt normal bone turnover and create a vicious cycle to which treatment efforts should be directed. Bisphosphonates have been used safely for more than two decades. As a group they delay time to first skeletal related event and reduce pain, but do not prevent development of bone metastasis in patients with no bone metastasis, and also do not prolong survival. The receptor activator for nuclear factor kB ligand inhibitor denosumab delays time to first skeletal related event and reduces the skeletal morbidity rate. Radionuclides are another treatment option for bone pain. New targeted therapies and radionuclides are still under investigation. In this review we will focus on mechanisms of bone metastasis and its medical treatment in breast cancer patients.

Breast Cancer: Major Risk Factors and Recent Developments in Treatment

“…However biphosphonates do not have any preventive effect on breast cancer related bone metastasis and can't enhance the survival rate. Denosumab which is a radionuclide is a newer treatment which can also reduce the rate of skeletal morbidity along with delay of first skeletal event and also reduces bone pain (Erdogan and Cicin, 2014).…”

Lack of Efficacy of Tai Chi in Improving Quality of Life in Breast Cancer Survivors: a Systematic Review and Meta-analysis

“…At present, breast cancer is generally treated with the possible medical treatment, i.e., a multidisciplinary approach is preferable (Saini et al, 2012). However, some studies found that older breast cancer survivors (BCS) showed multiple indications of decrements in their health-related quality of life (QoL), and bone mineral density (BMD) (Yusuf et al, 2013;Erdogan et al, 2014). The emotional impact of cancer diagnosis, symptoms, and related issues can be severe.…”

Platycodin D Blocks Breast Cancer-Induced Bone Destruction by Inhibiting Osteoclastogenesis and the Growth of Breast Cancer Cells

“…Most osteolytic factors stimulate osteoclast bone resorption and consequently decreasing the survival rates of breast cancer patients [21]. Therefore, bisphosphonates (anti-bone resorptive agents) and denosumab (a monoclonal antibody against RANKL), which were primarily developed as therapeutic agents for osteoporosis, have been used in therapy for patients with bone metastatic breast cancer [9,36]. Platycodin D noticeably suppressed the number of multinucleated osteoclasts in the BMMs that were treated with RANKL and the osteoclast-mediated formation of the resorption pit.…”