Biochemical markers in the management of patients with metastatic bone disease.

Abstract

Patients with cancer usually die not as a result of their primary malignancy but of the metastatic disease process that ultimately develops. One-third of cancer patients will have metastases of their primary tumor to bone (1). The metastatic spread of cancer to bone is common to many different malignancies, particularly breast (73%), prostate (68%), and lung (36%) cancers (2). Bone metastases, in fact, account for the highest proportion of first sites of relapse in breast cancer patients. Metastases to bone cause accelerated bone resorption both from direct effects of the tumor itself and through the activation of osteoclast cells in bone via humoral and growth factors such as cytokines, platelet-derived growth factor, and parathyroid hormone-related protein (3). For most cancer patients, treatment of advanced metastatic disease is usually palliative, with quality of life a primary goal of therapy. Although patients will develop visceral as well as bony metastases, in many cases metastasis is exclusively to bone. There are numerous clinical consequences of metastatic bone disease, including hypercalcemia, bone pain, pathological fractures, and spinal cord compression. In many of these patients, appropriate therapy can resolve the hypercalcemia, improve the bone pain, and ward off the development of pathological fractures that compromise the mobility and quality of life for these …