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 κB 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.
Highlights
The most common site of breast cancer metastasis is bone; most of the patients whom died because of breast cancer have bone metastasis in postmortem examination (Coleman et al, 1987)
Bone has a huge source of growth factors, cell adhesion molecules and cytokines that makes it fertile soil for metastasized breast cancer cells to survive
Pamidronate is another nitrogen containing bisphosphonate that has been found beneficial in breast cancer patients with osteolytic bone metastasis
Summary
The most common site of breast cancer metastasis is bone; most of the patients whom died because of breast cancer have bone metastasis in postmortem examination (Coleman et al, 1987). Time to the first SRE has been significantly delayed by clodronate therapy in these trials Pamidronate is another nitrogen containing bisphosphonate that has been found beneficial in breast cancer patients with osteolytic bone metastasis. The primary end point is not reached, in this trail 4mg zoledronic acid delayed time to first SRE (310 days vs 174 days, p=0.013) and yielded 20% reduction in the risk of SRE (HR, 0.801; p=0.037) compared to pamidronate This trial extended to 24 months, 412 patients with breast cancer involved in extended study (Rosen et al, 2003). The morbidity period rate, new SRE and delaying time to largest clinical trial (2046 patients with breast cancer bone first new SRE, it reduced pain scores (Body et al, metastasis) that compared denosumab with zoledronic. Administration of ibandronate can be advantageous for Even if extraskeletal metastasis is present, ASCO does not
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