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Fornetti J, Welm AL, Stewart SA. Understanding the Bone in Cancer Metastasis. J Bone Miner Res 2018; 33:2099-2113. [PMID: 30476357 DOI: 10.1002/jbmr.3618] [Citation(s) in RCA: 248] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 10/17/2018] [Accepted: 10/18/2018] [Indexed: 12/11/2022]
Abstract
The bone is the third most common site of metastasis for a wide range of solid tumors including lung, breast, prostate, colorectal, thyroid, gynecologic, and melanoma, with 70% of metastatic prostate and breast cancer patients harboring bone metastasis.1 Unfortunately, once cancer spreads to the bone, it is rarely cured and is associated with a wide range of morbidities including pain, increased risk of fracture, and hypercalcemia. This fact has driven experts in the fields of bone and cancer biology to study the bone, and has revealed that there is a great deal that each can teach the other. The complexity of the bone was first described in 1889 when Stephen Paget proposed that tumor cells have a proclivity for certain organs, where they "seed" into a friendly "soil" and eventually grow into metastatic lesions. Dr. Paget went on to argue that although many study the "seed" it would be paramount to understand the "soil." Since this original work, significant advances have been made not only in understanding the cell-autonomous mechanisms that drive metastasis, but also alterations which drive changes to the "soil" that allow a tumor cell to thrive. Indeed, it is now clear that the "soil" in different metastatic sites is unique, and thus the mechanisms that allow tumor cells to remain in a dormant or growing state are specific to the organ in question. In the bone, our knowledge of the components that contribute to this fertile "soil" continues to expand, but our understanding of how they impact tumor growth in the bone remains in its infancy. Indeed, we now appreciate that the endosteal niche likely contributes to tumor cell dormancy, and that osteoclasts, osteocytes, and adipocytes can impact tumor cell growth. Here, we discuss the bone microenvironment and how it impacts cancer cell seeding, dormancy, and growth. © 2018 American Society for Bone and Mineral Research.
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Affiliation(s)
- Jaime Fornetti
- Department of Oncological Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Alana L Welm
- Department of Oncological Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Sheila A Stewart
- Departments of Cell Biology and Physiology, Washington University School of Medicine, St. Louis, MO, USA.,Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA.,Integrating Communication within the Cancer Environment (ICCE) Institute, Washington University School of Medicine, St. Louis, MO, USA
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Zhang C, Zhang F, Liang G, Zeng X, Yu W, Jiang Z, Ma J, Zhao M, Xiong M, Gui K, Yuan F, Ji W. Denosumab versus zoledronic acid for preventing symptomatic skeletal events in Asian postmenopausal women with oestrogen-receptor-positive advanced breast cancer: an outcome analyses with a mean follow-up of 3 years. BMC Musculoskelet Disord 2018; 19:424. [PMID: 30497434 PMCID: PMC6267057 DOI: 10.1186/s12891-018-2338-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 11/12/2018] [Indexed: 01/20/2023] Open
Abstract
Background The purpose of this study was to evaluate the efficacy of denosumab or zoledronic acid (ZA) using symptomatic skeletal events (SSEs) as the primary endpoint in Asian postmenopausal women with oestrogen-receptor-positive advanced breast cancer. Methods Asian postmenopausal women with oestrogen-receptor-positive advanced breast cancer receiving subcutaneous denosumab 120 mg Q4W, or intravenous ZA 4 mg Q4W until the primary analysis cut-off date were retrospectively analysed in the Hong Kong Practice-Based Cancer Research Center(HKCRC) from March 2011 to March 2013. The time to first on-study SSE that was assessed either clinically or through routine radiographic scans was the primary endpoint. Results 242 patients received denosumab or ZA treatment (n = 120, mean age of 64.9 years (SD 3.01) and n = 122, 65.4 years (3.44), respectively). The median times to first on-study SSE were 14.7 months (12.9–45.6) and 11.7 months (9.9–45.6) for denosumab and ZA, respectively (hazard ratio, HR 0.44, 95% CI 0.71–2.95; p = 0·0002). Compared with the ZA group, denosumab-treated patients had a significantly delayed time to first SSE (HR 0.65 [95% CI 0.29–1.45], p < 0.0001). An increased incidence of SSE was found in the 16-month follow-up with rates of 2.1 and 10.7% for denosumab and ZA, respectively (P = 0.033). The difference persisted with time with rates of 8.3 and 17.2% at the final follow-up, respectively (P < 0.05). Conclusion In postmenopausal women aged ≥60 years with oestrogen-receptor-positive advanced breast cancer, denosumab significantly reduced the risk of developing SSEs compared with ZA. The findings of this pilot trial justify a larger study to determine whether the result is more generally applicable to a broader population.
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Affiliation(s)
- Chi Zhang
- Department of Joint surgery; Translational Research Centre of Regenerative Medicine and 3D Printing Technologies of Guangzhou Medical University, The Third Affiliated Hospital of Guangzhou Medical University, Duobao Road No.63, Liwan District, Guangzhou, 510150, Guangdong, China.
| | - Fan Zhang
- Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, Huangpu East Road No. 183, Huangpu District, Guangzhou, 510700, Guangdong, China.
| | - Guanzhao Liang
- Department of Emergency, The First Affiliated Hospital of Sun Yat-sen University, Huangpu East Road No.183, Huangpu District, Guangzhou, 510700, Guangdong, China
| | - Xianshang Zeng
- Department of Orthopaedics, The First Affiliated Hospital of Sun Yat-sen University, Huangpu East Road No. 183, Huangpu District, Guangzhou, 510700, Guangdong, China
| | - Weiguang Yu
- Department of Orthopaedics, The First Affiliated Hospital of Sun Yat-sen University, Huangpu East Road No. 183, Huangpu District, Guangzhou, 510700, Guangdong, China
| | - Zhidao Jiang
- Department of breast surgery, Hongkong Elizabeth hospital, Gascoigne Road No.30, Kowloon, Hongkong, Kowloon, China
| | - Jie Ma
- Department of Pharmacy, The First Hospital of Jilin University, Changchun, Jilin, 130021, China
| | - Mingdong Zhao
- Department of Orthopaedics, Jinshan Hospital, Fudan University, Longhang Road No. 1508, Jinshan District, Shanghai, 201508, China.
| | - Min Xiong
- Department of Orthopaedics, Jinshan Hospital, Fudan University, Longhang Road No. 1508, Jinshan District, Shanghai, 201508, China
| | - Keke Gui
- Department of Orthopaedics, Jinshan Hospital, Fudan University, Longhang Road No. 1508, Jinshan District, Shanghai, 201508, China
| | - Fenglai Yuan
- Department of Orthopaedics and Central Laboratory, The Third Hospital Affiliated to Nantong University, Wuxi, 214041, Jiangsu, China.
| | - Weiping Ji
- Department of General Surgery, The second affiliated hospital and Yuying children's hospital of Wenzhou Medical University, Zhejiang, 325003, China
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Wöckel A, Festl J, Stüber T, Brust K, Krockenberger M, Heuschmann PU, Jírů-Hillmann S, Albert US, Budach W, Follmann M, Janni W, Kopp I, Kreienberg R, Kühn T, Langer T, Nothacker M, Scharl A, Schreer I, Link H, Engel J, Fehm T, Weis J, Welt A, Steckelberg A, Feyer P, König K, Hahne A, Baumgartner T, Kreipe HH, Knoefel WT, Denkinger M, Brucker S, Lüftner D, Kubisch C, Gerlach C, Lebeau A, Siedentopf F, Petersen C, Bartsch HH, Schulz-Wendtland R, Hahn M, Hanf V, Müller-Schimpfle M, Henscher U, Roncarati R, Katalinic A, Heitmann C, Honegger C, Paradies K, Bjelic-Radisic V, Degenhardt F, Wenz F, Rick O, Hölzel D, Zaiss M, Kemper G, Budach V, Denkert C, Gerber B, Tesch H, Hirsmüller S, Sinn HP, Dunst J, Münstedt K, Bick U, Fallenberg E, Tholen R, Hung R, Baumann F, Beckmann MW, Blohmer J, Fasching P, Lux MP, Harbeck N, Hadji P, Hauner H, Heywang-Köbrunner S, Huober J, Hübner J, Jackisch C, Loibl S, Lück HJ, von Minckwitz G, Möbus V, Müller V, Nöthlings U, Schmidt M, Schmutzler R, Schneeweiss A, Schütz F, Stickeler E, Thomssen C, Untch M, Wesselmann S, Bücker A, Buck A, Stangl S. Interdisciplinary Screening, Diagnosis, Therapy and Follow-up of Breast Cancer. Guideline of the DGGG and the DKG (S3-Level, AWMF Registry Number 032/045OL, December 2017) - Part 2 with Recommendations for the Therapy of Primary, Recurrent and Advanced Breast Cancer. Geburtshilfe Frauenheilkd 2018; 78:1056-1088. [PMID: 30581198 PMCID: PMC6261741 DOI: 10.1055/a-0646-4630] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 06/20/2018] [Indexed: 12/29/2022] Open
Abstract
Purpose The aim of this official guideline coordinated and published by the German Society for Gynecology and Obstetrics (DGGG) and the German Cancer Society (DKG) was to optimize the screening, diagnosis, therapy and follow-up care of breast cancer. Method The process of updating the S3 guideline published in 2012 was based on the adaptation of identified source guidelines. They were combined with reviews of evidence compiled using PICO (Patients/Interventions/Control/Outcome) questions and with the results of a systematic search of literature databases followed by the selection and evaluation of the identified literature. The interdisciplinary working groups took the identified materials as their starting point and used them to develop suggestions for recommendations and statements, which were then modified and graded in a structured consensus process procedure. Recommendations Part 2 of this short version of the guideline presents recommendations for the therapy of primary, recurrent and metastatic breast cancer. Loco-regional therapies are de-escalated in the current guideline. In addition to reducing the safety margins for surgical procedures, the guideline also recommends reducing the radicality of axillary surgery. The choice and extent of systemic therapy depends on the respective tumor biology. New substances are becoming available, particularly to treat metastatic breast cancer.
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Affiliation(s)
- Achim Wöckel
- Universitätsfrauenklinik Würzburg, Universität Würzburg, Würzburg, Germany
| | - Jasmin Festl
- Universitätsfrauenklinik Würzburg, Universität Würzburg, Würzburg, Germany
| | - Tanja Stüber
- Universitätsfrauenklinik Würzburg, Universität Würzburg, Würzburg, Germany
| | - Katharina Brust
- Universitätsfrauenklinik Würzburg, Universität Würzburg, Würzburg, Germany
| | | | - Peter U. Heuschmann
- Institut für Klinische Epidemiologie und Biometrie (IKE-B), Universität Würzburg, Würzburg, Germany
| | - Steffi Jírů-Hillmann
- Institut für Klinische Epidemiologie und Biometrie (IKE-B), Universität Würzburg, Würzburg, Germany
| | | | - Wilfried Budach
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | | | | | - Ina Kopp
- AWMF-Institut für Medizinisches Wissensmanagement, Marburg, Germany
| | | | - Thorsten Kühn
- Frauenklinik, Klinikum Esslingen, Esslingen, Germany
| | - Thomas Langer
- Office des Leitlinienprogrammes Onkologie, Berlin, Germany
| | - Monika Nothacker
- AWMF-Institut für Medizinisches Wissensmanagement, Marburg, Germany
| | - Anton Scharl
- Frauenklinik, Klinikum St. Marien Amberg, Amberg, Germany
| | | | - Hartmut Link
- Praxis für Hämatologie und Onkologie, Kaiserslautern, Germany
| | - Jutta Engel
- Tumorregister München, Institut für medizinische Informationsverarbeitung, Biometrie und Epidemiologie, Ludwig-Maximilians-Universität München, München, Germany
| | - Tanja Fehm
- Universitätsfrauenklinik Düsseldorf, Düsseldorf, Germany
| | - Joachim Weis
- Stiftungsprofessur Selbsthilfeforschung, Tumorzentrum/CCC Freiburg, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Anja Welt
- Innere Klinik (Tumorforschung), Westdeutsches Tumorzentrum, Universitätsklinikum Essen, Essen, Germany
| | | | - Petra Feyer
- Klinik für Strahlentherapie und Radioonkologie, Vivantes Klinikum, Neukölln Berlin, Germany
| | - Klaus König
- Berufsverband der Frauenärzte, Steinbach, Germany
| | | | | | - Hans H. Kreipe
- Institut für Pathologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Wolfram Trudo Knoefel
- Klinik für Allgemein-, Viszeral- und Kinderchirurgie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Michael Denkinger
- AGAPLESION Bethesda Klinik, Geriatrie der Universität Ulm, Ulm, Germany
| | - Sara Brucker
- Universitätsfrauenklinik Tübingen, Tübingen, Germany
| | - Diana Lüftner
- Medizinische Klinik mit Schwerpunkt Hämatologie, Onkologie und Tumorimmunologie, Campus Benjamin Franklin, Universitätsklinikum Charité, Berlin, Germany
| | - Christian Kubisch
- Institut für Humangenetik, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Christina Gerlach
- III. Medizinische Klinik und Poliklinik, uct, Interdisziplinäre Abteilung für Palliativmedizin, Universitätsmedizin der Johannes Gutenberg Universität, Mainz, Germany
| | - Annette Lebeau
- Institut für Pathologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | | | - Cordula Petersen
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - Markus Hahn
- Universitätsfrauenklinik Tübingen, Tübingen, Germany
| | - Volker Hanf
- Frauenklinik Nathanstift, Klinikum Fürth, Fürth, Germany
| | | | | | - Renza Roncarati
- Frauenselbsthilfe nach Krebs – Bundesverband e. V., Bonn, Germany
| | - Alexander Katalinic
- Institut für Sozialmedizin und Epidemiologie, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Christoph Heitmann
- Ästhetisch plastische und rekonstruktive Chirurgie, Camparihaus München, München, Germany
| | | | - Kerstin Paradies
- Konferenz Onkologischer Kranken- und Kinderkrankenpflege, Hamburg, Germany
| | - Vesna Bjelic-Radisic
- Universitätsfrauenklinik, Abteilung für Gynäkologie, Medizinische Universität Graz, Graz, Austria
| | - Friedrich Degenhardt
- Klinik für Frauenheilkunde und Geburtshilfe, Medizinische Hochschule Hannover, Hannover, Germany
| | - Frederik Wenz
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Mannheim, Mannheim, Germany
| | - Oliver Rick
- Klinik Reinhardshöhe Bad Wildungen, Bad Wildungen, Germany
| | - Dieter Hölzel
- Tumorregister München, Institut für medizinische Informationsverarbeitung, Biometrie und Epidemiologie, Ludwig-Maximilians-Universität München, München, Germany
| | - Matthias Zaiss
- Praxis für interdisziplinäre Onkologie & Hämatologie, Freiburg, Germany
| | | | - Volker Budach
- Klinik für Radioonkologie und Strahlentherapie, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Carsten Denkert
- Institut für Pathologie, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Bernd Gerber
- Universitätsfrauenklinik am Klinikum Südstadt, Rostock, Germany
| | - Hans Tesch
- Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany
| | | | - Hans-Peter Sinn
- Pathologisches Institut, Universität Heidelberg, Heidelberg, Germany
| | - Jürgen Dunst
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Karsten Münstedt
- Frauenklinik Offenburg, Ortenau Klinikum Offenburg-Gengenbach, Offenburg, Germany
| | - Ulrich Bick
- Klinik für Radiologie, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Eva Fallenberg
- Klinik für Radiologie, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Reina Tholen
- Deutscher Verband für Physiotherapie, Referat Bildung und Wissenschaft, Köln, Germany
| | - Roswita Hung
- Frauenselbsthilfe nach Krebs, Wolfsburg, Germany
| | - Freerk Baumann
- Centrum für Integrierte Onkologie Köln, Uniklinik Köln, Köln, Germany
| | - Matthias W. Beckmann
- Frauenklinik, Universitätsklinikum Erlangen, CCC Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Jens Blohmer
- Klinik für Gynäkologie incl. Brustzentrum, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Peter Fasching
- Frauenklinik, Universitätsklinikum Erlangen, CCC Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Michael P. Lux
- Frauenklinik, Universitätsklinikum Erlangen, CCC Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Nadia Harbeck
- Brustzentrum, Frauenklinik, Universität München (LMU), München, Germany
| | - Peyman Hadji
- Klinik für Gynäkologie und Geburtshilfe, Krankenhaus Nordwest, Frankfurt, Germany
| | - Hans Hauner
- Lehrstuhl für Ernährungsmedizin, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | | | | | - Jutta Hübner
- Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
| | - Christian Jackisch
- Klinik für Gynäkologie und Geburtshilfe, Sana Klinikum Offenbach, Offenbach, Germany
| | | | | | | | - Volker Möbus
- Klinik für Gynäkologie und Geburtshilfe, Klinikum Frankfurt Höchst, Frankfurt, Germany
| | - Volkmar Müller
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Ute Nöthlings
- Institut für Ernährungs- und Lebensmittelwissenschaften, Rheinische Friedrich-Wilhelms Universität Bonn, Bonn, Germany
| | - Marcus Schmidt
- Klinik und Poliklinik für Geburtshilfe und Frauengesundheit, Universitätsmedizin der Johannes Gutenberg-Universität Mai, Germany nz, Mainz
| | - Rita Schmutzler
- Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum Köln, Köln, Germany
| | - Andreas Schneeweiss
- Nationales Centrum für Tumorerkrankungen, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Florian Schütz
- Nationales Centrum für Tumorerkrankungen, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Elmar Stickeler
- Klinik für Gynäkologie und Geburtsmedizin, Uniklinik RWTH Aachen, Aachen, Germany
| | | | - Michael Untch
- Klinik für Geburtshilfe und Gynäkologie, Helios Klinikum Berlin-Buch, Berlin, Germany
| | | | - Arno Bücker
- Klinik für Diagnostische und Interventionelle Radiologie am UKS, Universität des Saarlandes, Homburg, Germany
| | - Andreas Buck
- Nuklearmedizinische Klinik und Poliklinik des Universitätsklinikums Würzburg, Würzburg, Germany
| | - Stephanie Stangl
- Institut für Klinische Epidemiologie und Biometrie (IKE-B), Universität Würzburg, Würzburg, Germany
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Heeke A, Nunes MR, Lynce F. Bone-Modifying Agents in Early-Stage and Advanced Breast Cancer. CURRENT BREAST CANCER REPORTS 2018; 10:241-250. [PMID: 30581537 PMCID: PMC6276066 DOI: 10.1007/s12609-018-0295-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE OF REVIEW Bone-modifying agents have an important role in the treatment of patients with bone mineral density loss, early-stage breast cancer to reduce risk of recurrence, and metastatic breast cancer with bone involvement. Here we review mechanisms of action of these agents and clinical indications for their use. RECENT FINDINGS The meta-analysis undertaken by the Early Breast Cancer Trialists' Collaborative Group showed that the use of bisphosphonates was associated with a decreased risk of breast cancer recurrence. SUMMARY The effect of bisphosphonates and receptor activator of nuclear factor kappa-B ligand inhibitors on bone health provides an opportunity to decrease the incidence of skeletal-related events and improve cancer outcomes in certain subsets of patients.
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Affiliation(s)
- Arielle Heeke
- Levine Cancer Institute, Atrium Health, Charlotte, NC USA
| | - Maria Raquel Nunes
- Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, MD USA
| | - Filipa Lynce
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC USA
- Lombardi Comprehensive Cancer Center, MedStar Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC 20057 USA
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Non-hormonal Chemoprevention. CURRENT BREAST CANCER REPORTS 2018. [DOI: 10.1007/s12609-018-0294-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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106
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Coleman RE, Collinson M, Gregory W, Marshall H, Bell R, Dodwell D, Keane M, Gil M, Barrett-Lee P, Ritchie D, Bowman A, Liversedge V, De Boer RH, Passos-Coelho JL, O'Reilly S, Bertelli G, Joffe J, Brown JE, Wilson C, Tercero JC, Jean-Mairet J, Gomis R, Cameron D. Benefits and risks of adjuvant treatment with zoledronic acid in stage II/III breast cancer. 10 years follow-up of the AZURE randomized clinical trial (BIG 01/04). J Bone Oncol 2018; 13:123-135. [PMID: 30591866 PMCID: PMC6303395 DOI: 10.1016/j.jbo.2018.09.008] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 09/07/2018] [Accepted: 09/16/2018] [Indexed: 12/28/2022] Open
Abstract
Adjuvant bisphosphonates improve disease outcomes in postmenopausal early breast cancer (EBC) but the long-term effects are poorly described. The AZURE trial (ISRCTN79831382) was designed to determine whether adjuvant zoledronic acid (ZOL) improves disease outcomes in EBC. Previous analyses showed no effect on overall outcomes but identified benefits in postmenopausal women. Here we present the long-term risks and benefits of adjuvant ZOL with 10-years follow-up. Patients and methods 3360 patients with stage II/III breast cancer were included in an academic, international, phase III, randomized, open label trial. Patients were followed up on a regular schedule until 10 years. Patients were randomized on a 1:1 basis to standard adjuvant systemic therapy +/− intravenous ZOL 4 mg every 3–4 weeks x6, and then at reduced frequency to complete 5 years treatment. The primary outcome was disease free survival (DFS). Secondary outcomes included invasive DFS (IDFS), overall survival (OS), sites of recurrence, skeletal morbidity and treatment outcomes according to primary tumor amplification of the transcription factor, MAF. Pre-planned subgroup analyses focused on interactions between menopausal status and treatment effects. Results With a median follow up of 117 months [IQR 70.4–120.4), DFS and IDFS were similar in both arms (HRDFS = 0.94, 95%CI = 0.84–1.06, p = 0.340; HRIDFS = 0.91, 95%CI = 0.82–1.02, p = 0.116). However, outcomes remain improved with ZOL in postmenopausal women (HRDFS = 0.82, 95%CI = 0.67–1.00; HRIDFS = 0.78, 95%CI = 0.64–0.94). In the 79% of tested women with a MAF FISH negative tumor, ZOL improved IDFS (HRIDFS = 0.75, 95%CI = 0.58–0.97) and OS HROS = 0.69, 95%CI = 0.50–0.94), irrespective of menopause. ZOL did not improve disease outcomes in MAF FISH + tumors. Bone metastases as a first DFS recurrence (BDFS) were reduced with ZOL (HRB-DFS = 0.76, 95%CI = 0.63–0.92, p = 0.005). ZOL reduced skeletal morbidity with fewer fractures and skeletal events after disease recurrence. 30 cases of osteonecrosis of the jaw in the ZOL arm (1.8%) have occurred. Conclusions Disease benefits with adjuvant ZOL in postmenopausal early breast cancer persist at 10 years of follow-up. The biomarker MAF identified a patient subgroup that derived benefit from ZOL irrespective of menopausal status.
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Affiliation(s)
- R E Coleman
- Academic Unit of Clinical Oncology and Sheffield Experimental Cancer Medicine Center, Weston Park Hospital, University of Sheffield, Sheffield S10 2SJ, UK
| | - M Collinson
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - W Gregory
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - H Marshall
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - R Bell
- Andrew Love Cancer Centre, Geelong, Australia
| | - D Dodwell
- St James Institute of Oncology, University of Leeds, UK
| | - M Keane
- University Hospital Galway, Ireland
| | - M Gil
- Institut Català d´Oncologia - IDIBELL. L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - D Ritchie
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - A Bowman
- Edinburgh Cancer Research Centre, Western General Hospital, University of Edinburgh, UK
| | - V Liversedge
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - R H De Boer
- Royal Melbourne Hospital, Melbourne, Australia
| | | | | | | | - J Joffe
- Huddersfield Royal Infirmary, Huddersfield, UK
| | - J E Brown
- Academic Unit of Clinical Oncology and Sheffield Experimental Cancer Medicine Center, Weston Park Hospital, University of Sheffield, Sheffield S10 2SJ, UK
| | - C Wilson
- Academic Unit of Clinical Oncology and Sheffield Experimental Cancer Medicine Center, Weston Park Hospital, University of Sheffield, Sheffield S10 2SJ, UK
| | | | | | - R Gomis
- Institute for Research in Biomedicine (IRB Barcelona), Barcelona Science and Technology Institute, CIBERONC and Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - D Cameron
- Edinburgh Cancer Research Centre, Western General Hospital, University of Edinburgh, UK
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Kyvernitakis I, Kann PH, Thomasius F, Hars O, Hadji P. Prevention of breast cancer treatment-induced bone loss in premenopausal women treated with zoledronic acid: Final 5-year results from the randomized, double-blind, placebo-controlled ProBONE II trial. Bone 2018; 114:109-115. [PMID: 29908297 DOI: 10.1016/j.bone.2018.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 05/10/2018] [Accepted: 06/12/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Premenopausal women receiving chemotherapy or endocrine treatment for early breast cancer are at increased risk for cancer treatment induced bone loss (CTIBL). The aim of the randomized, double-blind ProBONE II trial was to investigate whether a 2-year adjuvant treatment with 4 mg intravenous zoledronic acid (ZOL) every 3 months versus placebo would prevent CTIBL after a five-year period. METHODS Thirty-one of the 34 participants in the ZOL arm and thirty-four of the 36 participants in the placebo arm were followed-up to the 5-year visit and completed the study as planned. The changes in Bone Mass Density (BMD) were assessed at baseline and each visit after treatment initiation. RESULTS After 24 months, BMD at the lumbar spine showed a 2.9% increase in patients treated with ZOL vs. a 7.1% decrease in placebo-treated participants compared to baseline (p < 0.001). Over the 60-month study period, we found a decrease of 2.2% vs. 7.3% in the BMD at the lumbar spine in patients receiving ZOL and placebo respectively (p < 0.001). Over the 60-month study period, BMD in the placebo arm showed a continuous decrease at all sites (p < 0001), whereas patients treated with ZOL reached baseline BMD-values at the femoral neck and total hip. CONCLUSIONS In ProBone II, a 2-year treatment with ZOL 4 mg intravenous every 3 months prevented cancer treatment induced bone loss in premenopausal women with breast cancer and maintained the BMD up to 3 years post-treatment.
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Affiliation(s)
- Ioannis Kyvernitakis
- Department of Obstetrics and Gynecology, Buergerhospital Frankfurt, Dr. Senckenberg Foundation and Goethe-University of Frankfurt, Germany; Faculty of Medicine, Philipps-University of Marburg, Germany.
| | - Peter Herbert Kann
- Division of Endocrinology, Diabetology and Osteology, Philipps-University of Marburg, Germany
| | - Friederike Thomasius
- Department of Bone Oncology, gyn. Endocrinology and Reproductive Medicine, Nordwest Hospital, Frankfurt, Germany
| | - Olaf Hars
- Statistical Institute Berlin, Germany
| | - Peyman Hadji
- Faculty of Medicine, Philipps-University of Marburg, Germany; Department of Bone Oncology, gyn. Endocrinology and Reproductive Medicine, Nordwest Hospital, Frankfurt, Germany
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108
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Rouach V, Goldshtein I, Wolf I, Catane R, Chodick G, Iton A, Stern N, Cohen D. Exposure to alendronate is associated with a lower risk of bone metastases in osteoporotic women with early breast cancer. J Bone Oncol 2018; 12:91-95. [PMID: 30148062 PMCID: PMC6107893 DOI: 10.1016/j.jbo.2018.07.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 07/24/2018] [Accepted: 07/24/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Bisphosphonate (BP) treatment to prevent bone loss in breast cancer patients is already well established. However, data on the association between oral BP exposure before cancer diagnosis and disease outcomes in patients with early breast cancer are still scarce. Limited information is available on alendronate, the most common oral agent for the treatment of post-menopausal osteoporosis, regarding the association with bone metastases. AIM To examine the association between oral bisphosphonate exposure before cancer diagnosis and the risk of bone metastases in osteoporotic women diagnosed with early breast cancer. SUBJECTS AND METHODS This historical cohort study was conducted at the oncology division at Tel Aviv Medical Center. The study population included post-menopausal women with early breast cancer, diagnosed between 2002 and 2012. Data on cancer characteristics, diagnosis of osteoporosis, prior bisphosphonate exposure and outcome were collected from medical files. RESULTS Among 297 osteoporotic women identified, 145 (49%) were treated with bisphosphonates (alendronate in 90% of the cases) before cancer diagnosis. BP-treated women were significantly older than the BP-naïve ones (67.9 years vs 64.6 years, p = 0.01), but comparable in risk factors and disease characteristics. Over a mean follow up of 5.6 years, nine cases of bone metastases were identified, eight of them among BP-naïve patient (cumulative incidence of 9.9%) and one among BP-treated patients (0.7%). In a multivariable Cox's proportional hazards survival model the use of BP prior to cancer diagnosis was associated with a hazard ratio of 0.04 (95%CI:0.004-0.403, p = 0.006) for bone metastasis. The HR remained similar after further adjustment for tumor stage and cancer therapy. CONCLUSIONS History of alendronate use is associated with a lower likelihood of bone metastases in postmenopausal women with early breast cancer. Oral bisphosphonate treatment could be sufficient for reducing the risk of bone metastases.
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Affiliation(s)
- Vanessa Rouach
- Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv-Sourasky Medical Center, Weizmann 6′, Tel Aviv, Israel
- School of Public Health and Stanley Steyer Institute for Cancer Epidemiology and Research, Tel Aviv University, Israel
| | - Inbal Goldshtein
- Epidemiology & Database Research, Maccabi Healthcare Services, Israel
| | - Ido Wolf
- Oncology Division, Tel Aviv Sourasky Medical Center, Israel
| | | | - Gabriel Chodick
- Epidemiology & Database Research, Maccabi Healthcare Services, Israel
- School of Public Health and Stanley Steyer Institute for Cancer Epidemiology and Research, Tel Aviv University, Israel
| | - Amit Iton
- Sackler School of Medicine, Tel Aviv University, Israel
| | - Naftali Stern
- Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv-Sourasky Medical Center, Weizmann 6′, Tel Aviv, Israel
| | - Daniel Cohen
- School of Public Health and Stanley Steyer Institute for Cancer Epidemiology and Research, Tel Aviv University, Israel
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109
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Oruç Z, Kaplan MA, Arslan Ç. An update on the currently available and future chemotherapy for treating bone metastases in breast cancer patients. Expert Opin Pharmacother 2018; 19:1305-1316. [PMID: 30129373 DOI: 10.1080/14656566.2018.1504922] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Bone metastases in breast cancer patients are a common clinical problem. Many factors influence the treatment decision, including tumor characteristics, previous treatment and tumor burden in the treatment of metastatic breast cancer. AREAS COVERED This present review summarizes the new treatment strategies and the chemotherapeutic agents currently available in the management of metastatic breast cancer with bone metastases. EXPERT OPINION Patients with bone metastases more often have hormone receptor-positive tumours. Although new treatment agents for metastatic breast cancer have been investigated, endocrine therapy is still considered as the treatment of choice for patients with bone metastases although chemotherapy still has an important place. In recent years, new chemotherapeutic agents such as etirinotecan and nab-paclitaxel have been established though there are few studies that have looked at particular types of metastases. In the last decade, therapies for bone metastasis resistant to endocrine therapy have predominantly focused on radiotherapy, surgical resection, chemotherapy, bone-targeting radiopharmaceuticals and targeted therapeutics. New targeted agents include: Src inhibitors, cathepsin K inhibitors, CXCR4 inhibitors, TGF-B blockade and integrin antagonists while drug delivery systems for chemotherapy have also been developed. These new treatment options could be future treatment options for bone metastatic disease if early promising results are confirmed by clinical trials.
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Affiliation(s)
- Zeynep Oruç
- a Department of Medical Oncology , Mersin City Hospital , Mersin , Turkey
| | - Muhammet Ali Kaplan
- b Department of Medical Oncology , Dicle University Faculty of Medicine , Diyarbakır , Turkey
| | - Çağatay Arslan
- c Department of Medical Oncology , Medical Park Hospital , Izmir , Turkey.,d Faculty of Medicine , Bahcesehir University , Istanbul , Turkey
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110
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Ubellacker JM, Baryawno N, Severe N, DeCristo MJ, Sceneay J, Hutchinson JN, Haider MT, Rhee CS, Qin Y, Gregory WM, Garrido-Castro AC, Holen I, Brown JE, Coleman RE, Scadden DT, McAllister SS. Modulating Bone Marrow Hematopoietic Lineage Potential to Prevent Bone Metastasis in Breast Cancer. Cancer Res 2018; 78:5300-5314. [PMID: 30065048 DOI: 10.1158/0008-5472.can-18-0548] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 06/12/2018] [Accepted: 07/23/2018] [Indexed: 12/20/2022]
Abstract
The presence of disseminated tumor cells in breast cancer patient bone marrow aspirates predicts decreased recurrence-free survival. Although it is appreciated that physiologic, pathologic, and therapeutic conditions impact hematopoiesis, it remains unclear whether targeting hematopoiesis presents opportunities for limiting bone metastasis. Using preclinical breast cancer models, we discovered that marrow from mice treated with the bisphosphonate zoledronic acid (ZA) are metastasis-suppressive. Specifically, ZA modulated hematopoietic myeloid/osteoclast progenitor cell (M/OCP) lineage potential to activate metastasis-suppressive activity. Granulocyte-colony stimulating factor (G-CSF) promoted ZA resistance by redirecting M/OCP differentiation. We identified M/OCP and bone marrow transcriptional programs associated with metastasis suppression and ZA resistance. Analysis of patient blood samples taken at randomization revealed that women with high-plasma G-CSF experienced significantly worse outcome with adjuvant ZA than those with lower G-CSF levels. Our findings support discovery of therapeutic strategies to direct M/OCP lineage potential and biomarkers that stratify responses in patients at risk of recurrence.Significance: Bone marrow myeloid/osteoclast progenitor cell lineage potential has a profound impact on breast cancer bone metastasis and can be modulated by G-CSF and bone-targeting agents. Cancer Res; 78(18); 5300-14. ©2018 AACR.
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Affiliation(s)
- Jessalyn M Ubellacker
- Hematology Division, Brigham & Women's Hospital, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Ninib Baryawno
- Department of Stem Cell and Regenerative Biology, Harvard University, Cambridge, Massachusetts.,Center for Regenerative Medicine and the Cancer Center, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Stem Cell Institute, Cambridge, Massachusetts
| | - Nicolas Severe
- Department of Stem Cell and Regenerative Biology, Harvard University, Cambridge, Massachusetts.,Center for Regenerative Medicine and the Cancer Center, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Stem Cell Institute, Cambridge, Massachusetts
| | - Molly J DeCristo
- Hematology Division, Brigham & Women's Hospital, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Jaclyn Sceneay
- Hematology Division, Brigham & Women's Hospital, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - John N Hutchinson
- Department of Biostatistics, Harvard T.H. Chan, School of Public Health, Boston, Massachusetts
| | - Marie-Therese Haider
- Academic Unit of Clinical Oncology, Department of Oncology & Metabolism, Weston Park Hospital, University of Sheffield, Sheffield, United Kingdom
| | - Catherine S Rhee
- Department of Stem Cell and Regenerative Biology, Harvard University, Cambridge, Massachusetts.,Center for Regenerative Medicine and the Cancer Center, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Stem Cell Institute, Cambridge, Massachusetts
| | - Yuanbo Qin
- Hematology Division, Brigham & Women's Hospital, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Walter M Gregory
- Clinical Trials Research Unit, University of Leeds, Leeds, United Kingdom
| | - Ana C Garrido-Castro
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Ingunn Holen
- Academic Unit of Clinical Oncology, Department of Oncology & Metabolism, Weston Park Hospital, University of Sheffield, Sheffield, United Kingdom
| | - Janet E Brown
- Academic Unit of Clinical Oncology, Department of Oncology & Metabolism, Weston Park Hospital, University of Sheffield, Sheffield, United Kingdom
| | - Robert E Coleman
- Academic Unit of Clinical Oncology, Department of Oncology & Metabolism, Weston Park Hospital, University of Sheffield, Sheffield, United Kingdom
| | - David T Scadden
- Department of Stem Cell and Regenerative Biology, Harvard University, Cambridge, Massachusetts.,Center for Regenerative Medicine and the Cancer Center, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Stem Cell Institute, Cambridge, Massachusetts.,Broad Institute of Harvard and MIT, Cambridge, Massachusetts
| | - Sandra S McAllister
- Hematology Division, Brigham & Women's Hospital, Boston, Massachusetts. .,Department of Medicine, Harvard Medical School, Boston, Massachusetts.,Harvard Stem Cell Institute, Cambridge, Massachusetts.,Broad Institute of Harvard and MIT, Cambridge, Massachusetts
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111
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Salamanna F, Borsari V, Contartese D, Nicoli Aldini N, Fini M. Link between estrogen deficiency osteoporosis and susceptibility to bone metastases: A way towards precision medicine in cancer patients. Breast 2018; 41:42-50. [PMID: 30007267 DOI: 10.1016/j.breast.2018.06.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 06/21/2018] [Indexed: 01/18/2023] Open
Abstract
Different fields of cancer management consider bone health to be of increasing clinical importance for patients: 1) presence of bone metastases in many solid tumors, 2) use of bone-targeted treatments in the reduction of bone metastasis, 3) effects of cancer treatment on reproductive hormones, critical for normal bone remodeling maintenance. Additionally, bone microenvironment is further complicated by the decline of ovarian sex steroid production and by the related increase in inflammatory factors linked to menopause, which result in accelerated bone loss and increased risk of osteoporosis (OP). Similarly, cancers and metastasis to bone showed a close relationship with sex hormones (particularly estrogen). Thus, these findings raise a question: Could pre-existing estrogen deficiency OP promote and/or influence cancer cell homing and tumor growth in bone? Although some preclinical and clinical evidence exists, it is mandatory to understand this aspect that would be relevant in the clinical theatre, where physicians need to understand the treatments available to reduce the risk of skeletal disease in cancer patients. This descriptive systematic review summarizes preclinical and clinical studies dealing with bimodal interactions between pre-existing estrogen deficiency OP and bone metastasis development and provides evidence supporting differences in tumor growth and colonization between healthy and OP status. Few studies evaluated the impact of estrogen deficiency OP on the susceptibility to bone metastases. Therefore, implementing biological knowledge, could help researchers and clinicians to have a better comprehension of the importance of pre- and post-menopausal bone microenvironment and its clinical implications for precision medicine in cancer patients.
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Affiliation(s)
- F Salamanna
- Laboratory of Preclinical and Surgical Studies, Rizzoli RIT Department, IRCCS Rizzoli Orthopedic Institute, Via di Barbiano 1/10, Bologna, 40136, Italy
| | - V Borsari
- Laboratory of Preclinical and Surgical Studies, Rizzoli RIT Department, IRCCS Rizzoli Orthopedic Institute, Via di Barbiano 1/10, Bologna, 40136, Italy.
| | - D Contartese
- Laboratory of Preclinical and Surgical Studies, Rizzoli RIT Department, IRCCS Rizzoli Orthopedic Institute, Via di Barbiano 1/10, Bologna, 40136, Italy
| | - N Nicoli Aldini
- Laboratory of Preclinical and Surgical Studies, Rizzoli RIT Department, IRCCS Rizzoli Orthopedic Institute, Via di Barbiano 1/10, Bologna, 40136, Italy
| | - M Fini
- Laboratory of Biomechanics and Technology Innovation, Rizzoli RIT Department, IRCCS Rizzoli Orthopedic Institute, Via di Barbiano 1/10, Bologna, 40136, Italy
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112
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PD-1 blockade in combination with zoledronic acid to enhance the antitumor efficacy in the breast cancer mouse model. BMC Cancer 2018; 18:669. [PMID: 29921237 PMCID: PMC6009040 DOI: 10.1186/s12885-018-4412-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 04/19/2018] [Indexed: 01/20/2023] Open
Abstract
Background Blockade of PD-1 receptor may provide proof of concepts for the activity of an immune-modulation approach for the treatment of breast cancer (BC). Zoledronic acid (ZA) has been proven to inhibit angiogenesis, invasion, and adhesion of tumor cells. The aim of this study was to investigate the potential of monoclonal antibody against T cell checkpoint PD-1 in combination with chemotherapeutic drug ZA in BC mouse model. Methods The 4 T1-fLuc mouse BC model was used in this study. The anti-tumor efficacy of anti-PD-1 antibody alone or in combination with ZA was monitored by measuring bioluminescence imaging (BLI) and tumor volume. At the end of study, the flow cytometry was used to determine the immune cell population in tumors after different treatment. Results The results showed that mice treated with the combination therapy of anti-PD-1 antibody plus ZA exhibited better antitumor response compared to untreated controls or single therapy with no obvious toxicity. Conclusion Our study provides preclinical evidence for the enhanced BC treatment benefit through targeting co-signal molecules by combining anti-PD-1 antibody plus ZA treatment.
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113
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Bone resorption and bone metastasis risk. Med Hypotheses 2018; 118:36-41. [PMID: 30037612 DOI: 10.1016/j.mehy.2018.06.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 05/30/2018] [Accepted: 06/15/2018] [Indexed: 11/21/2022]
Abstract
Breast cancer tumors have a tendency to metastasize to the bone. After development of a bone metastasis, the median survival time is 40 months. Currently, little is known about the modifiable risk factors for developing bone metastases in women diagnosed with breast cancer. One possible modifiable risk factor is increased bone resorption. Increased bone resorption is caused by an imbalance between osteoblasts and osteoclasts favoring osteoclast-driven bone resorption. Osteoclast activity results in the release of growth factors from the bony matrix that are requirement for successful breast cancer tumor cell proliferation within the bone. Mice studies have shown that mice that have been genetically engineered to have higher bone mineral density, and thus lower bone resorption, have a decreased incidence of bone metastases. Alternatively, mice genetically engineered to have lower bone mineral density or increased bone resorption have a higher incidence of bone metastases. In human studies, antiosteoporotic drugs have been shown to decrease osteoclast activity and prevent bone metastases. These studies suggest that increased osteoclast activity, which results in low bone mineral density, may be a modifiable risk factor for developing bone metastases in women with breast cancer. Women undergoing chemotherapy for breast cancer develop low bone mineral density in response to the direct effects of chemotherapeutic drugs on bone cells-including osteoclasts, osteoblasts, and osteocytes-and through the decrease in circulating estrogen as a result of chemotherapy-induced ovarian dysfunction. Therefore, it is important for future studies to determine the risk of developing bone metastases associated with increasing bone resorption as measured by low or decreasing bone mineral density in women diagnosed with breast cancer, as well as to determine the best intervention(s) to promote a balance between osteoclasts and osteoblasts to favor osteoblast activity during chemotherapy treatment.
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114
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Steenbruggen TG, van Ramshorst MS, Kok M, Linn SC, Smorenburg CH, Sonke GS. Neoadjuvant Therapy for Breast Cancer: Established Concepts and Emerging Strategies. Drugs 2018; 77:1313-1336. [PMID: 28616845 DOI: 10.1007/s40265-017-0774-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
In the last decade, the systemic treatment approach for patients with early breast cancer has partly shifted from adjuvant treatment to neoadjuvant treatment. Systemic treatment administration started as a 'one size fits all' approach but is currently customized according to each breast cancer subtype. Systemic treatment in a neoadjuvant setting is at least as effective as in an adjuvant setting and has several additional advantages. First, it enables response monitoring and provides prognostic information; second, it downstages the tumor, allowing for less extensive surgery, improved cosmetic outcomes, and reduced postoperative complications such as lymphedema; and third, it enables early development of new treatment strategies by using pathological complete remission as a surrogate outcome of event-free and overall survival. In this review we give an overview of the current standard of neoadjuvant systemic treatment strategies for the three main subtypes of breast cancer: hormone receptor-positive, triple-negative, and human epidermal growth factor receptor 2-positive. Additionally, we summarize drugs that are under investigation for use in the neoadjuvant setting.
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Affiliation(s)
- Tessa G Steenbruggen
- Department of Medical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands
| | - Mette S van Ramshorst
- Department of Medical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands
| | - Marleen Kok
- Department of Medical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands
| | - Sabine C Linn
- Department of Medical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands
| | - Carolien H Smorenburg
- Department of Medical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands
| | - Gabe S Sonke
- Department of Medical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands.
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115
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Taxel P, Faircloth E, Idrees S, Van Poznak C. Cancer Treatment-Induced Bone Loss in Women With Breast Cancer and Men With Prostate Cancer. J Endocr Soc 2018; 2:574-588. [PMID: 29942922 PMCID: PMC6007245 DOI: 10.1210/js.2018-00052] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 05/15/2018] [Indexed: 12/14/2022] Open
Abstract
Cancer and cancer therapies can have a negative impact on bone health. Because cancer is a common diagnosis, survivorship concerns for osteoporosis and fragility fractures are an important component of care. This review addresses management of bone health in nonmetastatic cancer survivorship with a focus on breast cancer and prostate cancer.
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Affiliation(s)
| | | | - Sana Idrees
- Saint Vincent's Hospital, Bridgeport, Connecticut
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116
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Santa-Maria CA, Bardia A, Blackford AL, Snyder C, Connolly RM, Fetting JH, Hayes DF, Jeter SC, Miller RS, Nguyen A, Quinlan K, Rosner GL, Slater S, Storniolo AM, Wolff AC, Zorzi J, Henry NL, Stearns V. A phase II study evaluating the efficacy of zoledronic acid in prevention of aromatase inhibitor-associated musculoskeletal symptoms: the ZAP trial. Breast Cancer Res Treat 2018; 171:121-129. [PMID: 29752687 DOI: 10.1007/s10549-018-4811-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 05/02/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE Aromatase inhibitor-associated musculoskeletal symptoms (AIMSS) are common adverse events of AIs often leading to drug discontinuation. We initiated a prospective clinical trial to evaluate whether bisphosphonates are associated with reduced incidence of AIMSS. METHODS In the single-arm trial, the Zoledronic Acid Prophylaxis (ZAP) trial, we compared the incidence of AIMSS against historical controls from the Exemestane and Letrozole Pharmacogenomics (ELPh) trial. Eligible women were postmenopausal with stage 0-III breast cancer planning to receive adjuvant AIs. AIMSS was assessed using the Health Assessment Questionnaire and Visual Analog Scale over 12 months in both trials. Participants in the ZAP trial received zoledronic acid prior to initiating letrozole and after 6 months; ELPh participants included in the analysis were taking letrozole but not bisphosphonates. We analyzed patient-reported outcomes (PROs) and bone density in the ZAP trial using mixed-effects linear regression models and paired t tests, respectively. RESULTS From 2011 to 2013, 59 postmenopausal women enrolled in ZAP trial. All 59 (100%) women received baseline and 52 (88%) received 6-month zoledronic acid, and had similar characteristics to historical controls from the ELPh trial (n = 206). Cumulatively during the first year of AI, 37 and 67% of ZAP and ELPh participants reported AIMSS (p < 0.001), respectively. Within the ZAP trial, we did not observe significant changes in other PROs; however, we report improvements in bone mineral density. CONCLUSIONS Compared to historical controls, zoledronic acid administered concomitantly with adjuvant AIs was associated with a reduced incidence of AIMSS. A randomized controlled trial is required to confirm these findings.
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Affiliation(s)
- Cesar A Santa-Maria
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Aditya Bardia
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Massachusetts General Hospital Cancer Center, Boston, USA
| | - Amanda L Blackford
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Claire Snyder
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Roisin M Connolly
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - John H Fetting
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Daniel F Hayes
- University of Michigan Comprehensive Cancer Center, Ann Arbor, USA
| | - Stacie C Jeter
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Anne Nguyen
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, USA
| | - Katie Quinlan
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Gary L Rosner
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Shannon Slater
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Antonio C Wolff
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jane Zorzi
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Nora Lynn Henry
- University of Michigan Comprehensive Cancer Center, Ann Arbor, USA
- University of Utah, Salt Lake City, USA
| | - Vered Stearns
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA.
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117
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Cao Q, Chen X, Wu X, Liao R, Huang P, Tan Y, Wang L, Ren G, Huang J, Dong C. Inhibition of UGT8 suppresses basal-like breast cancer progression by attenuating sulfatide-αVβ5 axis. J Exp Med 2018; 215:1679-1692. [PMID: 29728441 PMCID: PMC5987921 DOI: 10.1084/jem.20172048] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 03/08/2018] [Accepted: 04/06/2018] [Indexed: 12/15/2022] Open
Abstract
Cao et al. show that UGT8 promotes BLBC progression through activating sulfatide–αVβ5 axis. ZA is identified as a direct inhibitor of UGT8 and suppresses BLBC progression, suggesting that inhibition of UGT8 offers a promising opportunity for treating BLBC. Basal-like breast cancer (BLBC) is associated with a poor clinical outcome as a result of the few treatment options and poor therapeutic response. Here, we report that elevated expression of urine diphosphate–galactose ceramide galactosyltransferase (UGT8) specifically occurs in BLBC and predicts poor prognosis in breast cancer patients. UGT8 expression is transcriptionally up-regulated by Sox10, triggering the sulfatide biosynthetic pathway; increased sulfatide activates integrin αVβ5-mediated signaling that contributes to BLBC progression. UGT8 expression promotes, whereas UGT8 knockdown suppresses tumorigenicity and metastasis. Importantly, we identify that zoledronic acid (ZA), a marketed drug for treating osteoporosis and bone metastasis, is a direct inhibitor of UGT8, which blocks the sulfatide biosynthetic pathway. Significantly, a clinically achievable dosage of ZA exhibits apparent inhibitory effect on migration, invasion, and lung metastasis of BLBC cells. Together, our study suggests that UGT8 is a potential prognostic indicator and druggable target of BLBC and that pharmacologic inhibition of UGT8 by ZA offers a promising opportunity for treating this challenging disease.
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Affiliation(s)
- Qianhua Cao
- Department of Pathology and Pathophysiology and Department of Surgical Oncology (Breast Center), The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Zhejiang Key Laboratory for Disease Proteomics, Zhejiang University School of Medicine, Hangzhou, China
| | - Xingyu Chen
- Department of Pathology and Pathophysiology and Department of Surgical Oncology (Breast Center), The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Zhejiang Key Laboratory for Disease Proteomics, Zhejiang University School of Medicine, Hangzhou, China
| | - Xuebiao Wu
- Department of Pathology and Pathophysiology and Department of Surgical Oncology (Breast Center), The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Zhejiang Key Laboratory for Disease Proteomics, Zhejiang University School of Medicine, Hangzhou, China
| | - Ruocen Liao
- Department of Pathology and Pathophysiology and Department of Surgical Oncology (Breast Center), The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Zhejiang Key Laboratory for Disease Proteomics, Zhejiang University School of Medicine, Hangzhou, China
| | - Panpan Huang
- Department of Pathology and Pathophysiology and Department of Surgical Oncology (Breast Center), The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Zhejiang Key Laboratory for Disease Proteomics, Zhejiang University School of Medicine, Hangzhou, China
| | - Yanjia Tan
- Department of Pathology and Pathophysiology and Department of Surgical Oncology (Breast Center), The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Zhejiang Key Laboratory for Disease Proteomics, Zhejiang University School of Medicine, Hangzhou, China
| | - Li Wang
- Department of Pathology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Guoping Ren
- Department of Pathology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jian Huang
- Department of Pathology and Pathophysiology and Department of Surgical Oncology (Breast Center), The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chenfang Dong
- Department of Pathology and Pathophysiology and Department of Surgical Oncology (Breast Center), The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China .,Zhejiang Key Laboratory for Disease Proteomics, Zhejiang University School of Medicine, Hangzhou, China
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118
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Wilson C, Bell R, Hinsley S, Marshall H, Brown J, Cameron D, Dodwell D, Coleman R. Adjuvant zoledronic acid reduces fractures in breast cancer patients; an AZURE (BIG 01/04) study. Eur J Cancer 2018; 94:70-78. [PMID: 29544162 DOI: 10.1016/j.ejca.2018.02.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 02/05/2018] [Accepted: 02/07/2018] [Indexed: 11/27/2022]
Abstract
The fracture impact of adjuvant bisphosphonates in breast cancer is not defined with most trials reporting changes in bone mineral density as a surrogate. The AZURE trial (ISRCTN79831382) evaluated the impact of adjuvant zoledronic acid (ZOL) on fractures. The AZURE trial is an academic, multi-centre, randomised phase III study evaluating the addition of ZOL 4 mg to standard therapy (neo/adjuvant chemotherapy and/or endocrine therapy) for 5 years (administered by intravenous (iv) infusion every 3-4 weeks for 6 doses, then 3 monthly × 8 and 6 monthly × 5) in patients with stage II/III early breast cancer. Fracture data collected as part of skeletal-related adverse event reporting were analysed after a median of 84.2 months of follow-up and 966 disease-free survival (DFS) events. We assessed number of fractures, time-to-first fracture and the incidence of fractures before and after disease recurrence. Two hundred forty-four patients reported ≥1 fracture, 140 (8.3%) in the control arm (171 fractures) and 104 (6.2%) in the ZOL arm (120 fractures). Of the 291 fractures reported, 207 fractures occurred in the absence of recurrence (control 111, ZOL 96), 80 after recurrence (control 59, ZOL 21). The 5-year fracture rate was reduced from 5.9% (95%CI 4.8, 7.1%; control) to 3.8% (95%CI 2.9, 4.7%) with ZOL. ZOL significantly increased time-to-first fracture (HR 0.69, 95%CI 0.53-0.90; P = 0.0053) but the majority of fracture prevention benefit occurred after a DFS event (HR 0.3; 95%CI 0.17, 0.53; P < 0.001). Fracture benefits from ZOL were similar across menopausal sub-groups. In conclusion, adjuvant ZOL reduced the risk of clinical fractures, the majority of this protection occurred after disease recurrence.
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Affiliation(s)
- C Wilson
- Academic Unit of Clinical Oncology, Weston Park Hospital, University of Sheffield, Sheffield, UK.
| | - R Bell
- Deakin University, Geelong, Australia
| | - S Hinsley
- Clinical Trials Research Unit, Leeds, UK
| | - H Marshall
- Clinical Trials Research Unit, Leeds, UK
| | - J Brown
- Academic Unit of Clinical Oncology, Weston Park Hospital, University of Sheffield, Sheffield, UK
| | - D Cameron
- Cancer Research UK Edinburgh Centre, Western General Hospital, University of Edinburgh, UK
| | - D Dodwell
- Institute of Oncology, Bexley Wing, St James Hospital, Leeds, UK
| | - R Coleman
- Academic Unit of Clinical Oncology, Weston Park Hospital, University of Sheffield, Sheffield, UK
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119
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Elsayed R, Abraham P, Awad ME, Kurago Z, Baladhandayutham B, Whitford GM, Pashley DH, McKenna CE, Elsalanty ME. Removal of matrix-bound zoledronate prevents post-extraction osteonecrosis of the jaw by rescuing osteoclast function. Bone 2018; 110:141-149. [PMID: 29408511 PMCID: PMC5878730 DOI: 10.1016/j.bone.2018.01.030] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 01/06/2018] [Accepted: 01/25/2018] [Indexed: 12/25/2022]
Abstract
Unlike other antiresorptive medications, bisphosphonate molecules accumulate in the bone matrix. Previous studies of side-effects of anti-resorptive treatment focused mainly on systemic effects. We hypothesize that matrix-bound bisphosphonate molecules contribute to the pathogenesis of bisphosphonate-related osteonecrosis of the jaw (BRONJ). In this study, we examined the effect of matrix-bound bisphosphonates on osteoclast differentiation in vitro using TRAP staining and resorption assay, with and without pretreatment with EDTA. We also tested the effect of zoledronate chelation on the healing of post-extraction defect in rats. Our results confirmed that bisphosphonates bind to, and can be chelated from, mineralized matrix in vitro in a dose-dependent manner. Matrix-bound bisphosphonates impaired the differentiation of osteoclasts, evidenced by TRAP activity and resorption assay. Zoledronate-treated rats that underwent bilateral dental extraction with unilateral EDTA treatment showed significant improvement in mucosal healing and micro-CT analysis on the chelated sides. The results suggest that matrix-bound bisphosphonates are accessible to osteoclasts and chelating agents and contribute to the pathogenesis of BRONJ. The use of topical chelating agents is a promising strategy for the prevention of BRONJ following dental procedures in bisphosphonate-treated patients.
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Affiliation(s)
- Ranya Elsayed
- Department of Oral Biology, Dental College of Georgia, Augusta University, Augusta, GA, USA
| | - Pheba Abraham
- Department of Oral Biology, Dental College of Georgia, Augusta University, Augusta, GA, USA
| | - Mohamed E Awad
- Department of Diagnostic Sciences, Dental College of Georgia, Augusta University, Augusta, GA, USA
| | - Zoya Kurago
- Department of Diagnostic Sciences, Dental College of Georgia, Augusta University, Augusta, GA, USA
| | | | - Gary M Whitford
- Department of Oral Biology, Dental College of Georgia, Augusta University, Augusta, GA, USA
| | - David H Pashley
- Department of Oral Biology, Dental College of Georgia, Augusta University, Augusta, GA, USA
| | - Charles E McKenna
- Department of Chemistry, Dana and David Dornsife College of Letters, Arts, and Sciences, University of Southern California, Los Angeles, CA, USA
| | - Mohammed E Elsalanty
- Department of Oral Biology, Dental College of Georgia, Augusta University, Augusta, GA, USA.
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120
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Strobl S, Wimmer K, Exner R, Devyatko Y, Bolliger M, Fitzal F, Gnant M. Adjuvant Bisphosphonate Therapy in Postmenopausal Breast Cancer. Curr Treat Options Oncol 2018. [DOI: 10.1007/s11864-018-0535-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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121
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Comito G, Pons Segura C, Taddei ML, Lanciotti M, Serni S, Morandi A, Chiarugi P, Giannoni E. Zoledronic acid impairs stromal reactivity by inhibiting M2-macrophages polarization and prostate cancer-associated fibroblasts. Oncotarget 2018; 8:118-132. [PMID: 27223431 PMCID: PMC5352046 DOI: 10.18632/oncotarget.9497] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 05/05/2016] [Indexed: 01/11/2023] Open
Abstract
Zoledronic acid (ZA) is a biphosphonate used for osteoporosis treatment and also proved to be effective to reduce the pain induced by bone metastases when used as adjuvant therapy in solid cancers. However, it has been recently proposed that ZA could have direct anti-tumour effects, although the molecular mechanism is unknown. We herein unravel a novel anti-tumour activity of ZA in prostate cancer (PCa), by targeting the pro-tumorigenic properties of both stromal and immune cells. Particularly, we demonstrate that ZA impairs PCa-induced M2-macrophages polarization, reducing their pro-invasive effect on tumour cells and their pro-angiogenic features. Crucially, ZA administration reverts cancer associated fibroblasts (CAFs) activation by targeting the mevalonate pathway and RhoA geranyl-geranylation, thereby impairing smooth muscle actin-α fibers organization, a prerequisite of fibroblast activation. Moreover, ZA prevents the M2 macrophages-mediated activation of normal fibroblast, highlighting the broad efficacy of this drug on tumour microenvironment. These results are confirmed in a metastatic xenograft PCa mouse model in which ZA-induced stromal normalization impairs cancer-stromal cells crosstalk, resulting in a significant reduction of primary tumour growth and metastases. Overall these findings reinforce the efficacy of ZA as a potential therapeutic approach to reduce cancer aggressiveness, by abrogating the supportive role of tumour microenvironment.
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Affiliation(s)
- Giuseppina Comito
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50134 Florence, Italy
| | - Coral Pons Segura
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50134 Florence, Italy
| | - Maria Letizia Taddei
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50134 Florence, Italy
| | - Michele Lanciotti
- Department of Urology, University of Florence, Careggi Hospital, Urologic Clinic San Luca, 50100 Florence, Italy
| | - Sergio Serni
- Department of Urology, University of Florence, Careggi Hospital, Urologic Clinic San Luca, 50100 Florence, Italy
| | - Andrea Morandi
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50134 Florence, Italy
| | - Paola Chiarugi
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50134 Florence, Italy.,Tuscany Tumor Institute and "Center for Research, Transfer and High Education DenoTHE", 50134 Florence, Italy
| | - Elisa Giannoni
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50134 Florence, Italy
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122
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Brook N, Brook E, Dharmarajan A, Dass CR, Chan A. Breast cancer bone metastases: pathogenesis and therapeutic targets. Int J Biochem Cell Biol 2018; 96:63-78. [DOI: 10.1016/j.biocel.2018.01.003] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 12/31/2017] [Accepted: 01/04/2018] [Indexed: 01/03/2023]
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123
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Jiang F, Liu S, Chen A, Li BY, Robling AG, Chen J, Yokota H. Finite Element Analysis of the Mouse Distal Femur with Tumor Burden in Response to Knee Loading. INTERNATIONAL JOURNAL OF ORTHOPAEDICS (HONG KONG) 2018; 5:863-871. [PMID: 30505850 PMCID: PMC6261479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Breast cancer-associated bone metastasis induces bone loss, followed by an increased risk of bone fracture. To develop a strategy for preventing tumor growth and protecting bone, an understanding of the mechanical properties of bone under tumor burden is indispensable. Using a mouse model of mammary tumor, we conducted finite element analysis (FEA) of two bone samples from the distal femur. One sample was from a placebo-treated mouse, and the other was from a mouse treated with the investigational drug candidate, PD407824, an inhibitor of checkpoint kinases. Mechanical testing and microCT images revealed that bone strength is improved by administration of PD407824. In response to loading to the knee, FEA predicted that the peaks of von Mises stress, an indicator of fracture yielding, as well as the third principal compressive stress, were higher in the placebo-treated femur than the drug-treated femur. Higher peak stresses in trabecular segments were observed in the lateral condyle, a critical region for integrity of the knee joint. Collectively, this FE study supports the notion that mechanical weakening of the femur was observed in the tumor-invaded trabecular bone, and chemical agents such as PD407824 may potentially assist in preventing bone loss and bone fracture.
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Affiliation(s)
- Feifei Jiang
- Department of Mechanical Engineering, Indiana University Purdue University Indianapolis, Indianapolis, IN 46202, USA
| | - Shengzhi Liu
- Department of Biomedical Engineering, Indiana University Purdue University Indianapolis, Indianapolis, IN 46202, USA
- Department of Pharmacology, School of Pharmacy, Harbin Medical University, Harbin 150081, China
| | - Andy Chen
- Department of Biomedical Engineering, Indiana University Purdue University Indianapolis, Indianapolis, IN 46202, USA
| | - Bai-Yan Li
- Department of Pharmacology, School of Pharmacy, Harbin Medical University, Harbin 150081, China
| | - Alexander G. Robling
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Jie Chen
- Department of Mechanical Engineering, Indiana University Purdue University Indianapolis, Indianapolis, IN 46202, USA
| | - Hiroki Yokota
- Department of Mechanical Engineering, Indiana University Purdue University Indianapolis, Indianapolis, IN 46202, USA
- Department of Biomedical Engineering, Indiana University Purdue University Indianapolis, Indianapolis, IN 46202, USA
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
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124
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Korde LA, Doody DR, Hsu L, Porter PL, Malone KE. Bisphosphonate Use and Risk of Recurrence, Second Primary Breast Cancer, and Breast Cancer Mortality in a Population-Based Cohort of Breast Cancer Patients. Cancer Epidemiol Biomarkers Prev 2018; 27:165-173. [PMID: 29254937 PMCID: PMC6021196 DOI: 10.1158/1055-9965.epi-17-0556] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 09/13/2017] [Accepted: 11/22/2017] [Indexed: 11/16/2022] Open
Abstract
Background: Studies of bisphosphonate use and breast cancer recurrence have produced conflicting results. Analyses of large adjuvant trials suggest that bisphosphonates reduce recurrence risk only in postmenopausal women.Methods: We assessed the effect of noncancer treatment-related bisphosphonate use on breast cancer outcomes in a population-based prognostic cohort of women with early-stage invasive breast cancer (n = 1,813; median follow-up = 11.8 years). Using medical record, interview, and cancer registry data, information was assembled on risk factors, cancer treatment, medication use, and outcomes. Statistical analyses used Cox proportional hazards regression models.Results: Bisphosphonate use was associated with a significantly decreased risk of a breast cancer event [locoregional/distant recurrence or second primary breast cancer; HR ever use, 0.65; 95% confidence interval (CI), 0.47-0.90]. Reduced risks were observed in both pre/peri and postmenopausal women, in both ER-negative and ER-positive breast cancers, and for both earlier and later recurrences. Bisphosphonate use was also associated with a significantly decreased risk of breast cancer mortality (HR, 0.40; 95% CI, 0.23-0.69).Conclusions: Bisphosphonate use was associated with a reduction in risk of breast cancer events and improved breast cancer-specific survival in women with early-stage breast cancer. We hypothesize that the benefit of bisphosphonates on breast cancer outcomes may be present primarily in women with low bone density and regardless of menopausal status.Impact: Our findings suggest further consideration of bone density status as a modifier of bisphosphonate's potential beneficial benefits on breast cancer outcomes is warranted. Cancer Epidemiol Biomarkers Prev; 27(2); 165-73. ©2017 AACR.
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Affiliation(s)
- Larissa A Korde
- School of Medicine, University of Washington, Seattle, Washington
- Divisions of Clinical Research and Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - David R Doody
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Li Hsu
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Peggy L Porter
- Divisions of Human Biology and Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Kathleen E Malone
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.
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125
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Sousa S, Clézardin P. Bone-Targeted Therapies in Cancer-Induced Bone Disease. Calcif Tissue Int 2018; 102:227-250. [PMID: 29079995 DOI: 10.1007/s00223-017-0353-5] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 10/19/2017] [Indexed: 01/14/2023]
Abstract
Cancer-induced bone disease is a major source of morbidity and mortality in cancer patients. Thus, effective bone-targeted therapies are essential to improve disease-free, overall survival and quality of life of cancer patients with bone metastases. Depending of the cancer-type, bone metastases mainly involve the modulation of osteoclast and/or osteoblast activity by tumour cells. To inhibit metastatic bone disease effectively, it is imperative to understand its underlying mechanisms and identify the target cells for therapy. If the aim is to prevent bone metastasis, it is essential to target not only bone metastatic features in the tumour cells, but also tumour-nurturing bone microenvironment properties. The currently available bone-targeted agents mainly affect osteoclasts, inhibiting bone resorption (e.g. bisphosphonates, denosumab). Some agents targeting osteoblasts begin to emerge which target osteoblasts (e.g. romosozumab), activating bone formation. Moreover, certain drugs initially thought to target only osteoclasts are now known to have a dual action (activating osteoblasts and inhibiting osteoclasts, e.g. proteasome inhibitors). This review will focus on the evolution of bone-targeted therapies for the treatment of cancer-induced bone disease, summarizing preclinical and clinical findings obtained with anti-resorptive and bone anabolic therapies.
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Affiliation(s)
- Sofia Sousa
- National Institute of Health and Medical Research (INSERM), UMR 1033, 69372, Lyon, France.
- Faculty of Medicine Laennec, University of Lyon-1, 69372, Villeurbanne, France.
| | - Philippe Clézardin
- National Institute of Health and Medical Research (INSERM), UMR 1033, 69372, Lyon, France
- Faculty of Medicine Laennec, University of Lyon-1, 69372, Villeurbanne, France
- European Cancer and Bone Metastasis Laboratory, Department of Bone Oncology and Metabolism, Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK
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126
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Lüftner D, Niepel D, Steger GG. Therapeutic approaches for protecting bone health in patients with breast cancer. Breast 2018; 37:28-35. [DOI: 10.1016/j.breast.2017.10.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 10/12/2017] [Accepted: 10/13/2017] [Indexed: 02/07/2023] Open
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127
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Liu S, Liu Y, Minami K, Chen A, Wan Q, Yin Y, Gan L, Xu A, Matsuura N, Koizumi M, Liu Y, Na S, Li J, Nakshatri H, Li BY, Yokota H. Inhibiting checkpoint kinase 1 protects bone from bone resorption by mammary tumor in a mouse model. Oncotarget 2018; 9:9364-9378. [PMID: 29507695 PMCID: PMC5823640 DOI: 10.18632/oncotarget.24286] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 01/13/2018] [Indexed: 12/22/2022] Open
Abstract
DNA damage response plays a critical role in tumor growth, but little is known about its potential role in bone metabolism. We employed selective inhibitors of Chk1 and examined their effects on the proliferation and migration of mammary tumor cells as well as the development of osteoblasts and osteoclasts. Further, using a mouse model of bone metastasis we evaluated the effects of Chk1 inhibitors on bone quality. Chk1 inhibitors blocked the proliferation, survival, and migration of tumor cells in vitro and suppressed the development of bone-resorbing osteoclasts by downregulating NFATc1. In the mouse model, Chk1 inhibitor reduced osteolytic lesions and prevented mechanical weakening of the femur and tibia. Analysis of RNA-seq expression data indicated that the observed effects were mediated through the regulation of eukaryotic translation initiation factor 2 alpha, stress to the endoplasmic reticulum, S100 proteins, and bone remodeling-linked genes. Our findings suggest that targeting Chk1 signaling without adding DNA damaging agents may protect bone from degradation while suppressing tumor growth and migration.
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Affiliation(s)
- Shengzhi Liu
- Department of Pharmacology, School of Pharmacy, Harbin Medical University, Harbin 150081, China.,Department of Biomedical Engineering, Indiana University at Purdue University, Indianapolis, IN 46202, USA
| | - Yang Liu
- Department of Pharmacology, School of Pharmacy, Harbin Medical University, Harbin 150081, China.,Department of Biomedical Engineering, Indiana University at Purdue University, Indianapolis, IN 46202, USA
| | - Kazumasa Minami
- Department of Biomedical Engineering, Indiana University at Purdue University, Indianapolis, IN 46202, USA.,Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine Suita, Osaka 565-0871, Japan
| | - Andy Chen
- Department of Biomedical Engineering, Indiana University at Purdue University, Indianapolis, IN 46202, USA
| | - Qiaoqiao Wan
- Department of Biomedical Engineering, Indiana University at Purdue University, Indianapolis, IN 46202, USA
| | - Yukun Yin
- Department of Biology, Indiana University at Purdue University, Indianapolis, IN 46202, USA
| | - Liangying Gan
- Department of Biology, Indiana University at Purdue University, Indianapolis, IN 46202, USA
| | - Aihua Xu
- Department of Biology, Indiana University at Purdue University, Indianapolis, IN 46202, USA
| | - Nariaki Matsuura
- Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka 537-8511, Japan
| | - Masahiko Koizumi
- Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine Suita, Osaka 565-0871, Japan
| | - Yunlong Liu
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Sungsoo Na
- Department of Biomedical Engineering, Indiana University at Purdue University, Indianapolis, IN 46202, USA
| | - Jiliang Li
- Department of Biology, Indiana University at Purdue University, Indianapolis, IN 46202, USA
| | - Harikrishna Nakshatri
- Department of Surgery, Simon Cancer Research Center, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Bai-Yan Li
- Department of Pharmacology, School of Pharmacy, Harbin Medical University, Harbin 150081, China
| | - Hiroki Yokota
- Department of Biomedical Engineering, Indiana University at Purdue University, Indianapolis, IN 46202, USA
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128
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Ishikawa T, Akazawa K, Hasegawa Y, Tanino H, Horiguchi J, Miura D, Hayashi M, Kohno N. Survival outcomes of neoadjuvant chemotherapy with zoledronic acid for HER2-negative breast cancer. J Surg Res 2017; 220:46-51. [DOI: 10.1016/j.jss.2017.05.066] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 04/11/2017] [Accepted: 05/19/2017] [Indexed: 01/06/2023]
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129
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Coleman R, Hall A, Albanell J, Hanby A, Bell R, Cameron D, Dodwell D, Marshall H, Jean-Mairet J, Tercero JC, Rojo F, Gregory W, Gomis RR. Effect of MAF amplification on treatment outcomes with adjuvant zoledronic acid in early breast cancer: a secondary analysis of the international, open-label, randomised, controlled, phase 3 AZURE (BIG 01/04) trial. Lancet Oncol 2017; 18:1543-1552. [PMID: 29037984 DOI: 10.1016/s1470-2045(17)30603-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 07/27/2017] [Accepted: 08/03/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Adjuvant use of bisphosphonates can reduce the incidence of bone metastases in early breast cancer. Recurrence and survival seem to be improved only in postmenopausal patients, but the underlying mechanisms remain unclear. We investigated whether MAF amplification (a biomarker for bone metastasis) in primary tumours could predict the treatment outcomes of adjuvant zoledronic acid. METHODS The study population included patients enrolled in the international, open-label, randomised, controlled, phase 3 AZURE trial at eligible UK sites who had stage II or III breast cancer and who gave consent for use of their primary tumour samples. Patients were randomly assigned (1:1) to receive standard adjuvant systemic therapy alone (control group) or with zoledronic acid every 3-4 weeks for six doses, then every 3-6 months until the end of 5 years. Minimisation took into account the number of involved axillary lymph nodes, clinical tumour stage, oestrogen-receptor status, type and timing of systemic therapy, menopausal status, statin use, and treating centre. The primary endpoint was disease-free survival; the secondary endpoint, invasive-disease-free survival, was the primary disease endpoint for the analysis in this report. MAF amplification was assessed by fluorescence in-situ hybridisation of two cores of breast tumour tissue in a microarray, done in a central laboratory by technicians unaware of treatment assignment. We used multivariate analyses to assess disease outcomes by intention to treat. We also assessed interactions between MAF-positive status and menopausal status on efficacy of zoledronic acid. The AZURE trial is registered with the International Standard Randomised Controlled Trial Registry, number ISRCTN79831382. FINDINGS 1739 AZURE patients contributed primary tumour samples, of whom 865 (50%) had two assessable cores (445 in the control groups and 420 in the zoledronic acid group). 184 (21%) tumours were MAF positive (85 in the control groups and 99 in the zoledronic acid group) and the remaining tumours were MAF negative. At a median follow-up of 84·6 months (IQR 72·0-95·8), MAF status was not prognostic for invasive-disease-free survival in the control group (MAF-positive vs MAF-negative: hazard ratio [HR] 0·92, 95% CI 0·59-1·41), but was in the zoledronic acid group (0·52, 0·36-0·75). In patients with MAF-negative tumours, zoledronic acid was associated with higher invasive-disease-free survival than was control treatment (HR 0·74, 95% CI 0·56-0·98), but not in patients who had MAF-positive tumours. Additionally, among 121 patients not postmenopausal at randomisation with MAF-positive tumours, zoledronic acid was associated with lower invasive-disease-free survival (HR 2·47, 95% CI 1·23-4·97) and overall survival (2·27, 95% CI 1·04-4·93) than control treatment. INTERPRETATION MAF status can predict likelihood of benefit from adjuvant zoledronic acid and merits further investigation as a potential companion diagnostic. FUNDING Novartis Global and Inbiomotion.
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Affiliation(s)
- Robert Coleman
- Academic Unit of Clinical Oncology, Weston Park Hospital, Sheffield, UK.
| | - Andrew Hall
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - Joan Albanell
- IMIM-CIBERONC, Barcelona; Medical Oncology Department, Hospital del Mar, Barcelona, Spain; Pompeu Fabra University, Barcelona, Spain
| | - Andrew Hanby
- Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | | | - David Cameron
- Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - David Dodwell
- St James Institute of Oncology, St James Hospital, Leeds, UK
| | - Helen Marshall
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | | | | | - Federico Rojo
- Fundación Jiménez Díaz, Madrid, Spain; CIBERONC, Madrid, Spain
| | - Walter Gregory
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - Roger R Gomis
- IMIM-CIBERONC, Barcelona; Institute for Research in Biomedicine (IRB Barcelona), Barcelona, Spain; Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
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130
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O'Carrigan B, Wong MHF, Willson ML, Stockler MR, Pavlakis N, Goodwin A. Bisphosphonates and other bone agents for breast cancer. Cochrane Database Syst Rev 2017; 10:CD003474. [PMID: 29082518 PMCID: PMC6485886 DOI: 10.1002/14651858.cd003474.pub4] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Bone is the most common site of metastatic disease associated with breast cancer (BC). Bisphosphonates inhibit osteoclast-mediated bone resorption, and novel targeted therapies such as denosumab inhibit other key bone metabolism pathways. We have studied these agents in both early breast cancer and advanced breast cancer settings. This is an update of the review originally published in 2002 and subsequently updated in 2005 and 2012. OBJECTIVES To assess the effects of bisphosphonates and other bone agents in addition to anti-cancer treatment: (i) in women with early breast cancer (EBC); (ii) in women with advanced breast cancer without bone metastases (ABC); and (iii) in women with metastatic breast cancer and bone metastases (BCBM). SEARCH METHODS In this review update, we searched Cochrane Breast Cancer's Specialised Register, CENTRAL, MEDLINE, Embase, the World Health Organization's International Clinical Trials Registry Platform (WHO ICTRP) and ClinicalTrials.gov on 19 September 2016. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing: (a) one treatment with a bisphosphonate/bone-acting agent with the same treatment without a bisphosphonate/bone-acting agent; (b) treatment with one bisphosphonate versus treatment with a different bisphosphonate; (c) treatment with a bisphosphonate versus another bone-acting agent of a different mechanism of action (e.g. denosumab); and (d) immediate treatment with a bisphosphonate/bone-acting agent versus delayed treatment of the same bisphosphonate/bone-acting agent. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data, and assessed risk of bias and quality of the evidence. The primary outcome measure was bone metastases for EBC and ABC, and a skeletal-related event (SRE) for BCBM. We derived risk ratios (RRs) for dichotomous outcomes and the meta-analyses used random-effects models. Secondary outcomes included overall survival and disease-free survival for EBC; we derived hazard ratios (HRs) for these time-to-event outcomes where possible. We collected toxicity and quality-of-life information. GRADE was used to assess the quality of evidence for the most important outcomes in each treatment setting. MAIN RESULTS We included 44 RCTs involving 37,302 women.In women with EBC, bisphosphonates were associated with a reduced risk of bone metastases compared to placebo/no bisphosphonate (RR 0.86, 95% confidence interval (CI) 0.75 to 0.99; P = 0.03, 11 studies; 15,005 women; moderate-quality evidence with no significant heterogeneity). Bisphosphonates provided an overall survival benefit with time-to-event data (HR 0.91, 95% CI 0.83 to 0.99; P = 0.04; 9 studies; 13,949 women; high-quality evidence with evidence of heterogeneity). Subgroup analysis by menopausal status showed a survival benefit from bisphosphonates in postmenopausal women (HR 0.77, 95% CI 0.66 to 0.90; P = 0.001; 4 studies; 6048 women; high-quality evidence with no evidence of heterogeneity) but no survival benefit for premenopausal women (HR 1.03, 95% CI 0.86 to 1.22; P = 0.78; 2 studies; 3501 women; high-quality evidence with no heterogeneity). There was evidence of no effect of bisphosphonates on disease-free survival (HR 0.94, 95% 0.87 to 1.02; P = 0.13; 7 studies; 12,578 women; high-quality evidence with significant heterogeneity present) however subgroup analyses showed a disease-free survival benefit from bisphosphonates in postmenopausal women only (HR 0.82, 95% CI 0.74 to 0.91; P < 0.001; 7 studies; 8314 women; high-quality evidence with no heterogeneity). Bisphosphonates did not significantly reduce the incidence of fractures when compared to placebo/no bisphosphonates (RR 0.77, 95% CI 0.54 to 1.08, P = 0.13, 6 studies, 7602 women; moderate-quality evidence due to wide confidence intervals). We await mature overall survival and disease-free survival results for denosumab trials.In women with ABC without clinically evident bone metastases, there was no evidence of an effect of bisphosphonates on bone metastases (RR 0.96, 95% CI 0.65 to 1.43; P = 0.86; 3 studies; 330 women; moderate-quality evidence with no heterogeneity) or overall survival (RR 0.89, 95% CI 0.73 to 1.09; P = 0.28; 3 studies; 330 women; high-quality evidence with no heterogeneity) compared to placebo/no bisphosphonates however the confidence intervals were wide. One study reported a trend towards an extended period of time without a SRE with bisphosphonate compared to placebo (low-quality evidence). One study reported quality of life and there was no apparent difference in scores between bisphosphonate and placebo (moderate-quality evidence).In women with BCBM, bisphosphonates reduced the SRE risk by 14% (RR 0.86, 95% CI 0.78 to 0.95; P = 0.003; 9 studies; 2810 women; high-quality evidence with evidence of heterogeneity) compared with placebo/no bisphosphonates. This benefit persisted when administering either intravenous or oral bisphosphonates versus placebo. Bisphosphonates delayed the median time to a SRE with a median ratio of 1.43 (95% CI 1.29 to 1.58; P < 0.00001; 9 studies; 2891 women; high-quality evidence with no heterogeneity) and reduced bone pain (in 6 out of 11 studies; moderate-quality evidence) compared to placebo/no bisphosphonate. Treatment with bisphosphonates did not appear to affect overall survival (RR 1.01, 95% CI 0.91 to 1.11; P = 0.85; 7 studies; 1935 women; moderate-quality evidence with significant heterogeneity). Quality-of-life scores were slightly better with bisphosphonates than placebo at comparable time points (in three out of five studies; moderate-quality evidence) however scores decreased during the course of the studies. Denosumab reduced the risk of developing a SRE compared with bisphosphonates by 22% (RR 0.78, 0.72 to 0.85; P < 0.001; 3 studies, 2345 women). One study reported data on overall survival and observed no difference in survival between denosumab and bisphosphonate.Reported toxicities across all settings were generally mild. Osteonecrosis of the jaw was rare, occurring less than 0.5% in the adjuvant setting (high-quality evidence). AUTHORS' CONCLUSIONS For women with EBC, bisphosphonates reduce the risk of bone metastases and provide an overall survival benefit compared to placebo or no bisphosphonates. There is preliminary evidence suggestive that bisphosphonates provide an overall survival and disease-free survival benefit in postmenopausal women only when compared to placebo or no bisphosphonate. This was not a planned subgroup for these early trials, and we await the completion of new large clinical trials assessing benefit for postmenopausal women. For women with BCBM, bisphosphonates reduce the risk of developing SREs, delay the median time to an SRE, and appear to reduce bone pain compared to placebo or no bisphosphonate.
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Affiliation(s)
- Brent O'Carrigan
- Chris O'Brien LifehouseMedical Oncology119‐143 Missenden RdCamperdownSydneyNSWUK2050
- The University of SydneyCamperdownAustralia
| | - Matthew HF Wong
- Gosford HospitalDepartment of Medical OncologyGosfordNew South WalesAustralia
| | - Melina L Willson
- NHMRC Clinical Trials Centre, The University of SydneySystematic Reviews and Health Technology AssessmentsLocked Bag 77SydneyNSWAustralia1450
| | - Martin R Stockler
- The University of SydneyNHMRC Clinical Trials Centre and Sydney Cancer CentreGH6 RPAHMissenden RoadCamperdownNSWAustralia2050
| | - Nick Pavlakis
- Royal North Shore HospitalDepartment of Medical OncologyPacific HighwaySt LeonardsNew South WalesAustralia2065
| | - Annabel Goodwin
- The University of Sydney, Concord Repatriation General HospitalConcord Clinical SchoolConcordNSWAustralia2137
- Concord Repatriation General HospitalMedical Oncology DepartmentConcordAustralia
- Sydney Local Health District and South Western Sydney Local Health DistrictCancer Genetics DepartmentSydneyAustralia
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131
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Brodowicz T, Hadji P, Niepel D, Diel I. Early identification and intervention matters: A comprehensive review of current evidence and recommendations for the monitoring of bone health in patients with cancer. Cancer Treat Rev 2017; 61:23-34. [PMID: 29100167 DOI: 10.1016/j.ctrv.2017.09.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 09/26/2017] [Accepted: 09/27/2017] [Indexed: 12/22/2022]
Abstract
Bone metastases are common in patients with advanced solid tumors, and many individuals experience debilitating skeletal-related events (SREs; e.g. pathologic fracture, hypercalcemia, radiotherapy or surgery to bone, and spinal cord compression). These events substantially affect disease outcomes, including survival and quality of life, and healthcare systems. Plain radiography is the most widely used imaging modality for the detection of bone metastases; skeletal scintigraphy, computed tomography, positron emission tomography and magnetic resonance imaging offer greater sensitivity but their use in routine practice is restricted by high costs and limited availability. Biomarkers of bone turnover may also have a role in the early detection of bone metastases and can provide valuable prognostic information on disease progression. SREs can be delayed or prevented using agents such as the receptor activator of nuclear factor kappa B ligand (RANKL) inhibitor, denosumab, and bisphosphonates. Painful bone metastases can be treated with radiofrequency ablation, radiotherapy, or radionuclides such as radium-223 dichloride, which has been shown to delay the onset of SREs in men with castration-resistant prostate cancer. Close monitoring of bone health in patients with advanced cancer may lead to early identification of individuals with bone metastases who could benefit from early intervention to prevent SREs. This review examines current guideline recommendations for assessing and monitoring bone health in patients with advanced cancer, use of biomarkers and treatment of patients with bone metastases. The emerging evidence for the potential survival benefit conferred by early intervention with denosumab and bisphosphonates is also discussed, together with best practice recommendations.
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Affiliation(s)
- Thomas Brodowicz
- Department of Medicine I and Comprehensive Cancer Center, Clinical Division of Oncology, Medical University of Vienna, General Hospital, Währinger Gürtel 18-20, 1090 Vienna, Austria.
| | - Peyman Hadji
- Department of Bone Oncology, Endocrinology and Reproductive Medicine, Northwest Hospital, Steinbacher Hohl 2-26, 60488 Frankfurt, Germany; Philipps-University of Marburg, Biegenstraße 10, 35037 Marburg, Germany.
| | - Daniela Niepel
- Amgen (GmbH) Europe, Dammstrasse 23, 6300 Zug, Switzerland.
| | - Ingo Diel
- Center for Comprehensive Gynecology, Augustaanlage 7-11, 68165 Mannheim, Germany.
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Corraini P, Heide-Jørgensen U, Schiødt M, Nørholt SE, Acquavella J, Sørensen HT, Ehrenstein V. Osteonecrosis of the jaw and survival of patients with cancer: a nationwide cohort study in Denmark. Cancer Med 2017; 6:2271-2277. [PMID: 28941210 PMCID: PMC5633555 DOI: 10.1002/cam4.1173] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 07/10/2017] [Accepted: 08/01/2017] [Indexed: 11/11/2022] Open
Abstract
Osteonecrosis of the jaw (ONJ) is an adverse effect of bone‐targeted therapies, which are used to prevent symptomatic skeletal events following bone malignancy. We examined the association between ONJ and survival among cancer patients treated with bone‐targeted agents. Using nationwide registries and databases in Denmark, we identified 184 cancer patients with incident ONJ between 2010 and 2015, and a comparison cohort of 1067 cancer patients without ONJ and with a history of hospital‐administered treatment with bisphosphonates or denosumab initiating from cancer diagnosis. At the date of confirmed ONJ diagnosis, the comparison cohort was matched to the ONJ patients on age, cancer site, year of cancer diagnosis, and stage at diagnosis. The patients were followed up for survival until emigration or 15 June 2016. We computed overall survival and estimated mortality rate ratios adjusted for sex, and for the presence of distant metastases and other comorbidity at start of follow‐up. A match was found for 149 of the 184 ONJ patients. The 1‐ and 3‐year survival among all 184 cancer patients with ONJ was 70% (95% confidence interval [CI]: 63%–76%) and 42% (95% CI: 34%–51%), respectively. Among the matched patients, ONJ was associated with an adjusted mortality rate ratio of 1.31 (95% CI: 1.01–1.71). ONJ was associated with reduced survival among cancer patients treated with bone‐targeted agents. ONJ may be a marker of advanced disease or of survival‐related lifestyle characteristics.
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Affiliation(s)
- Priscila Corraini
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Uffe Heide-Jørgensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Morten Schiødt
- Department of Oral and Maxillofacial Surgery, Rigshospitalet, Copenhagen Ø, Denmark
| | - Sven Erik Nørholt
- Department of Oral and Maxillofacial Surgery, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - John Acquavella
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Vera Ehrenstein
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
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D'Oronzo S, Brown J, Coleman R. The role of biomarkers in the management of bone-homing malignancies. J Bone Oncol 2017; 9:1-9. [PMID: 28948139 PMCID: PMC5602513 DOI: 10.1016/j.jbo.2017.09.001] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 09/04/2017] [Accepted: 09/05/2017] [Indexed: 12/19/2022] Open
Abstract
Bone represents a common site of metastasis from several solid tumours, including breast, prostate and lung malignancies. The onset of bone metastases (BM) is associated not only with serious skeletal complications, but also shortened overall survival, owing to the lack of curative treatment options for late-stage cancer. Despite the diagnostic advances, BM detection often occurs in the symptomatic stage, underlining the need for novel strategies aimed at the early identification of high-risk patients. To this purpose, both bone turnover and tumour-derived markers are being investigated for their potential diagnostic, prognostic and predictive roles. In this review, we summarize the pathogenesis of BM in breast, prostate and lung tumours, while exploring the current research focused on the identification and clinical validation of BM biomarkers.
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Key Words
- 1CTP, cross-linked carboxy-terminal telopeptide of type 1 collagen
- BALP, bone specific alkaline phosphatase
- BC, breast cancer
- BM, bone metastases
- BMDC, bone marrow derived cells
- BMPs, bone morphogenetic proteins
- BSP, bone sialoprotein
- BTA, bone-targeting agents
- BTM, bone turnover markers
- Biomarkers
- Bone metastasis
- Bone turnover markers
- Breast cancer
- CAPG, macrophage-capping protein
- CCL2, chemokine C-C ligand 2
- CTC, circulating tumour cells
- CXCL, C–X–C motif chemokine ligand
- CXCR, C–X–C motif chemokine receptor
- CaSR, calcium sensing receptor
- DPD, deoxypyridinoline
- DTC, disseminated tumour cells
- EMT, epithelial to mesenchymal transition
- ER, estrogen receptor
- FGF, fibroblast growth factor
- GIPC1, PDZ domain–containing protein member 1
- HR, hormone receptor
- Her2, human epidermal growth factor receptor 2
- IGF, insulin-like growth factor
- IL, interleukin
- IL-1R, IL-1 receptor
- LC, lung cancer
- Lung cancer
- M-CSF, macrophage colony stimulating factor
- MAF, v-maf avian musculo-aponeurotic fibrosarcoma oncogene homolog
- NSCLC, non-small cell LC
- NTX and CTX, N- and C- telopeptides of type 1 collagen
- OPG, osteoprotegerin
- P1NP and P1CP, N and C terminal pro-peptides of type 1 collagen
- PC, prostate cancer
- PDGF, platelet-derived growth factor
- PDGFRα, PDGF receptor α
- PSA, prostate specific antigen
- PTH, parathyroid hormone
- PTH-rP, PTH related protein
- PYD, pyridinoline
- PlGF, placental growth factor
- Prostate cancer
- RANK, receptor activator of nuclear factor kB
- RANK-L, RANK-ligand
- SDF-1, stromal cell-derived factor 1
- SREs, skeletal related events
- TGF-β, transforming growth factor-β
- TNF, tumour necrosis factor
- TRACP-5b, tartrate-resistant acid phosphatase type 5b
- TRAF3, TNF receptor associated factor 3
- VEGF, vascular endothelial growth factor
- ZNF217, zinc-finger protein 217
- miRNA, micro RNA
- sBALP, serum BALP
- shRNA, short hairpin RNA
- uNTX, urinary NTX
- β-CTX, CTX β isomer
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Affiliation(s)
- Stella D'Oronzo
- Academic Unit of Clinical Oncology, Weston Park Hospital, University of Sheffield, Whitham Road, Sheffield S10 2S, England, UK
| | - Janet Brown
- Academic Unit of Clinical Oncology, Weston Park Hospital, University of Sheffield, Whitham Road, Sheffield S10 2S, England, UK
| | - Robert Coleman
- Academic Unit of Clinical Oncology, Weston Park Hospital, University of Sheffield, Whitham Road, Sheffield S10 2S, England, UK
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Zekri J, Marples M, Taylor D, Kandukurti K, McParland L, Brown JE. Complications of bone metastases from malignant melanoma. J Bone Oncol 2017; 8:13-17. [PMID: 28856087 PMCID: PMC5568878 DOI: 10.1016/j.jbo.2017.08.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 08/08/2017] [Accepted: 08/10/2017] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Metastatic bone disease (MBD) carries significant morbidity for patients with cancer. MBD from malignant melanoma (MM) is understudied. We examined the characteristics, morbidity, management and outcome of MBD in patients with MM. METHODS Patients with metastatic MM managed at two referral cancer centres in England were identified. Those with bone metastases (BMs) were selected. Patient and disease characteristics including skeletal related events (SREs) were extracted from medical records. The Kaplan Meier method was used to calculate median survival. RESULTS Five hundred and eighteen patients with metastatic MM were managed between years 2000 and 2008. Eighty nine (17.2%) patients had BMs and are the subject of this study. Median age at diagnosis was 53 years and 55% were males. BMs were identified at the time of diagnosis of metastatic disease in 68.5% patients. Sixty-six (74.2%) had multiple bone lesions and 80.9% had axial skeleton involvement. One hundred and twenty nine skeletal related events occurred in 59 (66.3%) patients (50 radiotherapy, 28 hypercalcaemia, 20 bone fractures, 18 spinal cord compression and 13 orthopaedic surgery). The annual skeletal morbidity rate was 2.5. Median survival from diagnosis of BMs was 17.3 weeks and was 5.6 weeks from the first episode of hypercalcaemia. CONCLUSION MBD affects a clinically important proportion (17.2%) of patients with metastatic MM. It carries a substantial morbidity and mortality exceeding that caused by BMs from breast and prostate cancer. These patients should receive the currently licensed bone modifying agents and should be included in clinical trials addressing MBD.
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Affiliation(s)
- Jamal Zekri
- Weston Park Hospital, Sheffield S10 2SJ, England, UK
- Al-Faisal University, King Faisal Specialist Hospital & Research Centre, Jeddah, Saudi Arabia
| | - Maria Marples
- St James's Institute of Oncology, St James's University Hospital, Leeds LS9 7TF, UK
| | - Dominic Taylor
- St James's Institute of Oncology, St James's University Hospital, Leeds LS9 7TF, UK
| | | | - Lucy McParland
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds LS2 9PH, UK
| | - Janet E. Brown
- Academic Unit of Clinical Oncology, University of Sheffield, Weston Park Hospital, Sheffield S10 2SJ, England, UK
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135
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Cai XJ, Wang Z, Cao JW, Ni JJ, Xu YY, Yao J, Xu H, Liu F, Yang GY. Anti-angiogenic and anti-tumor effects of metronomic use of novel liposomal zoledronic acid depletes tumor-associated macrophages in triple negative breast cancer. Oncotarget 2017; 8:84248-84257. [PMID: 29137420 PMCID: PMC5663592 DOI: 10.18632/oncotarget.20539] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 07/30/2017] [Indexed: 12/26/2022] Open
Abstract
Zoledronic acid (ZOL) has been used as an adjuvant therapy for breast cancer. It is suggested that ZOL might be associated with inhibition of macrophages, which in turn reduces tumor growth, metastasis and tumor angiogenesis. Moreover, metronomic therapy can inhibit tumor angiogenesis and tumor immune cells. Previously we developed ZOL based cationic liposomes that allowed a higher intratumor delivery of drug compared with free ZOL in vivo. Therefore, in this study, Asn-Gly-Arg (NGR) and PEG2000 were used as ligands to modify the surface of liposomes (NGR-PEG-LP-ZOL) in metronomic therapy to clear the tumor-associated macrophages (TAMs) and inhibit the formation of tumor angiogenesis, achieving the purpose of anti-tumor growth. Our data showed that NGR-PEG-LP-ZOL metronomic therapy has the strongest inhibitory effect on tumor growth. Further, NGR-PEG-LP-ZOL metronomic therapy could significantly impair TAMs by inhibiting the expression of CD206 antibody in tumor tissues, decreasing the expression of cytokine related gene expression of TAMs, as well as reducing the percentage of TAMs in tumor tissues. In addition, NGR-PEG-LP-ZOL metronomic therapy could significantly inhibit the expression of tumor neovascular specific antibody CD31 and reduce the microvessel density. In conclusion, our study demonstrated that NGR-PEG-LP-ZOL metronomic therapy could impair TAMs by inhibiting tumor angiogenesis and enhance the antitumor effect of ZOL.
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Affiliation(s)
- Xin-Jun Cai
- Department of Pharmacy, Zhe Jiang Chinese Medicine and Western Medicine Integrated Hospital, Hangzhou 310003, People's Republic of China
| | - Zeng Wang
- Department of Pharmacy, Zhejiang Cancer Hospital, Hangzhou 310022, People's Republic of China
| | - Jia-Wei Cao
- Department of Pharmacy, Zhe Jiang Chinese Medicine and Western Medicine Integrated Hospital, Hangzhou 310003, People's Republic of China
| | - Jian-Jun Ni
- Department of Pharmacy, Zhe Jiang Chinese Medicine and Western Medicine Integrated Hospital, Hangzhou 310003, People's Republic of China
| | - Ying-Ying Xu
- Department of Pharmacy, Zhe Jiang Chinese Medicine and Western Medicine Integrated Hospital, Hangzhou 310003, People's Republic of China
| | - Jun Yao
- Department of Pharmacy, Zhe Jiang Chinese Medicine and Western Medicine Integrated Hospital, Hangzhou 310003, People's Republic of China
| | - Hong Xu
- Department of Gastroenterology and Hepatology, Integrated Chinese and Western Medicine Hospital of Zhejiang Province, Hangzhou 310003, People's Republic of China
| | - Fang Liu
- Department of Acupuncture, Integrated Chinese and Western Medicine Hospital of Zhejiang Province, Hangzhou 310003, People's Republic of China
| | - Gao-Yi Yang
- Department of Ultrasound, Integrated Chinese and Western Medicine Hospital of Zhejiang Province, Hangzhou 310003, People's Republic of China
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136
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Desai D, Zhang J, Sandholm J, Lehtimäki J, Grönroos T, Tuomela J, Rosenholm JM. Lipid Bilayer-Gated Mesoporous Silica Nanocarriers for Tumor-Targeted Delivery of Zoledronic Acid in Vivo. Mol Pharm 2017; 14:3218-3227. [PMID: 28737925 DOI: 10.1021/acs.molpharmaceut.7b00519] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Zoledronic acid (ZOL) is a nitrogen-containing bisphosphonate used for the treatment of bone diseases and calcium metabolism. Anticancer activity of ZOL has been established, but its extraskeletal effects are limited due to its rapid uptake and accumulation to bone hydroxyapatite. In this work, we report on the development of tethered lipid bilayer-gated mesoporous silica nanocarriers (MSNs) for the incorporation, retention, and intracellular delivery of ZOL. The in vitro anticancer activity of ZOL-loaded nanocarriers was evaluated by cell viability assay and live-cell imaging. For in vivo delivery, the nanocarriers were tagged with folic acid to boost the affinity for breast cancer cells. Histological examination of the liver revealed no adverse off-target effects stemming from the nanocarriers. Importantly, nonspecific accumulation of ZOL within bone was not observed, which indicated in vivo stability of the tethered lipid bilayers. Further, the intravenously administered ZOL-loaded nanocarriers showed tumor growth suppression in breast cancer xenograft-bearing mice.
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Affiliation(s)
- Diti Desai
- Pharmaceutical Sciences Laboratory, Faculty of Science and Engineering, Åbo Akademi University , Turku 20520, Finland
| | - Jixi Zhang
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University , Chongqing 400044, China
| | - Jouko Sandholm
- Cell Imaging Core, Turku Centre for Biotechnology, University of Turku and Åbo Akademi University , Turku 20520, Finland
| | - Jaakko Lehtimäki
- Institute of Biomedicine, University of Turku , Turku 20520, Finland
| | - Tove Grönroos
- Medicity Research Laboratory, University of Turku , Turku 20520, Finland.,Turku PET Centre, University of Turku , Turku 20520, Finland
| | - Johanna Tuomela
- Institute of Biomedicine, University of Turku , Turku 20520, Finland
| | - Jessica M Rosenholm
- Pharmaceutical Sciences Laboratory, Faculty of Science and Engineering, Åbo Akademi University , Turku 20520, Finland
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137
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Gielen E, Bergmann P, Bruyère O, Cavalier E, Delanaye P, Goemaere S, Kaufman JM, Locquet M, Reginster JY, Rozenberg S, Vandenbroucke AM, Body JJ. Osteoporosis in Frail Patients: A Consensus Paper of the Belgian Bone Club. Calcif Tissue Int 2017; 101:111-131. [PMID: 28324124 PMCID: PMC5498589 DOI: 10.1007/s00223-017-0266-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 03/02/2017] [Indexed: 12/11/2022]
Abstract
In this consensus paper, the Belgian Bone Club aims to provide a state of the art on the epidemiology, diagnosis, and management of osteoporosis in frail individuals, including patients with anorexia nervosa, patients on dialysis, cancer patients, persons with sarcopenia, and the oldest old. All these conditions may indeed induce bone loss that is superimposed on physiological bone loss and often remains under-recognized and under-treated. This is of particular concern because of the major burden of osteoporotic fractures in terms of morbidity, mortality, and economic cost. Therefore, there is an urgent need to appreciate bone loss associated with these conditions, as this may improve diagnosis and management of bone loss and fracture risk in clinical practice.
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Affiliation(s)
- E Gielen
- Gerontology and Geriatrics, Department of Clinical and Experimental Medicine, KU Leuven & Center for Metabolic Bone Diseases, UZ Leuven, Herestraat 49, 3000, Leuven, Belgium.
| | - P Bergmann
- Department of Radioisotopes, CHU Brugmann, Université Libre de Bruxelles, Bruxelles, Belgium
| | - O Bruyère
- Department of Public Health, Epidemiology and Health Economics, University of Liège, CHU de Liège, Liège, Belgium
| | - E Cavalier
- Department of Clinical Chemistry, UnilabLg, CIRM, University of Liège, CHU de Liège, Liège, Belgium
| | - P Delanaye
- Department of Nephrology, Dialysis, Transplantation, University of Liège, CHU de Liège, Liège, Belgium
| | - S Goemaere
- Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital, Ghent, Belgium
| | - J-M Kaufman
- Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital, Ghent, Belgium
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - M Locquet
- Department of Public Health, Epidemiology and Health Economics, University of Liège, CHU de Liège, Liège, Belgium
| | - J-Y Reginster
- Department of Public Health, Epidemiology and Health Economics, University of Liège, CHU de Liège, Liège, Belgium
| | - S Rozenberg
- Department of Gynaecology-Obstetrics, Université Libre de Bruxelles, Bruxelles, Belgium
| | - A-M Vandenbroucke
- Clinical Department of Internal Medicine, UZ Leuven, Leuven, Belgium
| | - J-J Body
- Department of Medicine, CHU Brugmann, Université Libre de Bruxelles, Bruxelles, Belgium
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138
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Systematic review and meta-analysis on the proportion of patients with breast cancer who develop bone metastases. Crit Rev Oncol Hematol 2017; 115:67-80. [DOI: 10.1016/j.critrevonc.2017.04.008] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 04/07/2017] [Accepted: 04/19/2017] [Indexed: 12/30/2022] Open
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Kamalakar A, Washam CL, Akel NS, Allen BJ, Williams DK, Swain FL, Leitzel K, Lipton A, Gaddy D, Suva LJ. PTHrP(12-48) Modulates the Bone Marrow Microenvironment and Suppresses Human Osteoclast Differentiation and Lifespan. J Bone Miner Res 2017; 32:1421-1431. [PMID: 28370412 PMCID: PMC5518789 DOI: 10.1002/jbmr.3142] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 03/09/2017] [Accepted: 03/24/2017] [Indexed: 01/08/2023]
Abstract
Bone is a common site for metastasis in breast cancer patients and is associated with a series of complications that significantly compromise patient survival, partially due to the advanced stage of disease at the time of detection. Currently, no clinically-approved biomarkers can identify or predict the development of bone metastasis. We recently identified a unique peptide fragment of parathyroid hormone-related protein (PTHrP), PTHrP(12-48), as a validated serum biomarker in breast cancer patients that correlates with and predicts the presence of bone metastases. In this study, the biological activity and mode of action of PTHrP(12-48) was investigated. Sequence-based and structure-based bioinformatics techniques predicted that the PTHrP(12-48) fragment formed an alpha helical core followed by an unstructured region after residue 40 or 42. Thereafter, detailed structure alignment and molecular docking simulations predicted a lack of interaction between PTHrP(12-48) and the cognate PTH1 receptor (PTHR1). The in silico prediction was confirmed by the lack of PTHrP(12-48)-stimulated cAMP accumulation in PTHR1-expressing human SaOS2 cells. Using a specific human PTHrP(12-48) antibody that we developed, PTHrP(12-48) was immunolocalized in primary and bone metastatic human breast cancer cells, as well as within human osteoclasts (OCLs) in bone metastasis biopsies, with little or no localization in other resident bone or bone marrow cells. In vitro, PTHrP(12-48) was internalized into cultured primary human OCLs and their precursors within 60 min. Interestingly, PTHrP(12-48) treatment dose-dependently suppressed osteoclastogenesis, via the induction of apoptosis in both OCL precursors as well as in mature OCLs, as measured by the activation of cleaved caspase 3. Collectively, these data suggest that PTHrP(12-48) is a bioactive breast cancer-derived peptide that locally regulates the differentiation of hematopoietic cells and the activity of osteoclasts within the tumor-bone marrow microenvironment, perhaps to facilitate tumor control of bone. © 2017 American Society for Bone and Mineral Research.
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Affiliation(s)
- Archana Kamalakar
- Department of Orthopaedic Surgery, Center for Orthopaedic Research, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, USA
| | - Charity L Washam
- Department of Orthopaedic Surgery, Center for Orthopaedic Research, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, USA
| | - Nisreen S Akel
- Department of Orthopaedic Surgery, Center for Orthopaedic Research, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, USA
| | - Bethany J Allen
- Department of Orthopaedic Surgery, Center for Orthopaedic Research, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, USA
| | - Diarra K Williams
- Department of Orthopaedic Surgery, Center for Orthopaedic Research, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, USA.,Department of Veterinary Physiology and Pharmacology, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA
| | - Frances L Swain
- Department of Orthopaedic Surgery, Center for Orthopaedic Research, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, USA
| | - Kim Leitzel
- Department of Medicine, Penn State University, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Allan Lipton
- Department of Medicine, Penn State University, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Dana Gaddy
- Department of Orthopaedic Surgery, Center for Orthopaedic Research, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, USA.,Veterinary Integrative Biosciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA
| | - Larry J Suva
- Department of Orthopaedic Surgery, Center for Orthopaedic Research, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, USA.,Department of Veterinary Physiology and Pharmacology, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA
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140
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D'Oronzo S, Brown J, Coleman R. The value of biomarkers in bone metastasis. Eur J Cancer Care (Engl) 2017; 26. [DOI: 10.1111/ecc.12725] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2017] [Indexed: 12/19/2022]
Affiliation(s)
- Stella D'Oronzo
- Academic Unit of Clinical Oncology; Weston Park Hospital; University of Sheffield; Sheffield UK
| | - Janet Brown
- Academic Unit of Clinical Oncology; Weston Park Hospital; University of Sheffield; Sheffield UK
| | - Robert Coleman
- Academic Unit of Clinical Oncology; Weston Park Hospital; University of Sheffield; Sheffield UK
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141
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Gnant M, Van Poznak C, Schnipper L. Therapeutic Bone-Modifying Agents in the Nonmetastatic Breast Cancer Setting: The Controversy and a Value Assessment. Am Soc Clin Oncol Educ Book 2017; 37:116-122. [PMID: 28561722 DOI: 10.1200/edbk_177357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Clinical trials and meta-analyses investigating bisphosphonates as an adjuvant breast cancer therapy have shown a consistent trend, with postmenopausal women and women receiving ovarian suppression with gonadotropin-releasing hormone therapy gaining improved breast cancer outcomes with the use of adjuvant bisphosphonate therapy. The interpretation of these data is controversial, because the primary endpoints of the majority of adjuvant bisphosphonate studies have been negative. Pros and cons as well as the value of adjuvant bisphosphonate therapy are discussed here.
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Affiliation(s)
- Michael Gnant
- From the Department of Surgery, Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel, Austria; University of Michigan, Ann Arbor, MI; Hematology/Oncology Division, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA
| | - Catherine Van Poznak
- From the Department of Surgery, Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel, Austria; University of Michigan, Ann Arbor, MI; Hematology/Oncology Division, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA
| | - Lowell Schnipper
- From the Department of Surgery, Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel, Austria; University of Michigan, Ann Arbor, MI; Hematology/Oncology Division, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA
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142
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Kassi E, Kapsali I, Kokkinos M, Gogas H. Treatment of severe hypocalcaemia due to osteoblastic metastases in a patient with post-thyroidectomy hypoparathyroidism with 153Sm-EDTMP. BMJ Case Rep 2017; 2017:bcr-2017-219354. [PMID: 28512123 PMCID: PMC5753734 DOI: 10.1136/bcr-2017-219354] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Symptomatic hypocalcaemia is an uncommon finding in patients with malignant tumours. We describe a patient with advanced metastatic breast cancer who developed severe hypocalcaemia caused by the combination of osteoblastic metastases and a permanent postoperative hypoparathyroidism. The patient failed to be treated with the conventional replacement therapy and was submitted effectively to radionucleotide therapy with 153Sm.
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Affiliation(s)
- Eva Kassi
- National and Kapodistrian University of Athens - Faculty of Medicine, Athens, Greece
| | - Ifigeneia Kapsali
- National and Kapodistrian University of Athens - Faculty of Medicine, Athens, Greece
| | - Michalis Kokkinos
- National and Kapodistrian University of Athens - Faculty of Medicine, Athens, Greece
| | - Helen Gogas
- National and Kapodistrian University of Athens - Faculty of Medicine, Athens, Greece
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143
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Lipton A, Chapman JAW, Leitzel K, Garg A, Pritchard KI, Ingle JN, Budd GT, Ellis MJ, Sledge GW, Rabaglio M, Han L, Elliott CR, Shepherd LE, Goss PE, Ali SM. Osteoporosis therapy and outcomes for postmenopausal patients with hormone receptor-positive breast cancer: NCIC CTG MA.27. Cancer 2017; 123:2444-2451. [DOI: 10.1002/cncr.30682] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 11/08/2016] [Accepted: 12/01/2016] [Indexed: 02/02/2023]
Affiliation(s)
- Allan Lipton
- Penn State Hershey Cancer Institute; Penn State Hershey Medical Center; Hershey Pennsylvania
| | | | - Kim Leitzel
- Penn State Hershey Cancer Institute; Penn State Hershey Medical Center; Hershey Pennsylvania
| | - Ashwani Garg
- Penn State Hershey Cancer Institute; Penn State Hershey Medical Center; Hershey Pennsylvania
| | - Kathleen I. Pritchard
- Sunnybrook Odette Cancer Centre; Toronto Sunnybrook Regional Cancer Centre; Toronto Ontario Canada
| | | | | | - Matthew J. Ellis
- Lester and Sue Smith Breast Center, Baylor College of Medicine; Houston Texas
| | | | - Manuela Rabaglio
- International Breast Cancer Study Group Coordinating Center and Inselspital; Bern Switzerland
| | - Lei Han
- Canadian Cancer Trials Group; Queen's University; Kingston Ontario Canada
| | | | - Lois E. Shepherd
- Canadian Cancer Trials Group; Queen's University; Kingston Ontario Canada
| | - Paul E. Goss
- Massachusetts General Hospital Cancer Center; Boston Massachusetts
| | - Suhail M. Ali
- Penn State Hershey Cancer Institute; Penn State Hershey Medical Center; Hershey Pennsylvania
- Lebanon VA Medical Center; Lebanon Pennsylvania
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144
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Stratton J, Hu X, Soulos PR, Davidoff AJ, Pusztai L, Gross CP, Mougalian SS. Bone Density Screening in Postmenopausal Women With Early-Stage Breast Cancer Treated With Aromatase Inhibitors. J Oncol Pract 2017; 13:e505-e515. [PMID: 28267392 DOI: 10.1200/jop.2016.018341] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE In postmenopausal women with breast cancer treated with aromatase inhibitors (AIs), most expert panels advise baseline bone mineral density testing with a dual-energy x-ray absorptiometry (DXA) scan repeated every 1 to 2 years. How often this recommendation is followed is unclear. METHODS We performed a retrospective analysis of women with stage I to III breast cancer who started AI therapy from January 1, 2008, to December 31, 2010, with follow-up through December 31, 2012, by using the SEER-Medicare database. Selection criteria included AI use for ≥ 6 months and no recent osteoporosis diagnosis or bisphosphonate use. We used multivariable logistic regression to investigate associations between patient characteristics and receipt of a baseline DXA scan. In patients who continued AI treatment, we assessed rates of follow-up scans. RESULTS In the sample of 2,409 patients (median age, 74 years), 51.0% received a baseline DXA scan. Demographic characteristics associated with the absence of a baseline DXA scan were older age (85 to 94 years v 67 to 69 years; odds ratio [OR], 0.62; 95% CI, 0.42 to 0.92) and black v white race (OR, 0.68; 95% CI, 0.47 to 0.97). Among patients who underwent a baseline DXA scan and continued AI for 3 years, 28.0% had a repeat DXA scan within 2 years and 65.9% within 3 years. In aggregate, of the 1,164 patients who continued with AI treatment for 3 years, only 34.5% had both a baseline and at least one DXA scan during the 3-year follow-up period. CONCLUSION The majority of older Medicare beneficiaries with breast cancer treated with AIs do not undergo appropriate bone mineral density evaluation.
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Affiliation(s)
- Jamie Stratton
- Yale University School of Medicine; and Yale Cancer Outcomes Public Policy and Effectiveness Research (COPPER) Center, New Haven, CT
| | - Xin Hu
- Yale University School of Medicine; and Yale Cancer Outcomes Public Policy and Effectiveness Research (COPPER) Center, New Haven, CT
| | - Pamela R Soulos
- Yale University School of Medicine; and Yale Cancer Outcomes Public Policy and Effectiveness Research (COPPER) Center, New Haven, CT
| | - Amy J Davidoff
- Yale University School of Medicine; and Yale Cancer Outcomes Public Policy and Effectiveness Research (COPPER) Center, New Haven, CT
| | - Lajos Pusztai
- Yale University School of Medicine; and Yale Cancer Outcomes Public Policy and Effectiveness Research (COPPER) Center, New Haven, CT
| | - Cary P Gross
- Yale University School of Medicine; and Yale Cancer Outcomes Public Policy and Effectiveness Research (COPPER) Center, New Haven, CT
| | - Sarah S Mougalian
- Yale University School of Medicine; and Yale Cancer Outcomes Public Policy and Effectiveness Research (COPPER) Center, New Haven, CT
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145
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Dhesy-Thind S, Fletcher GG, Blanchette PS, Clemons MJ, Dillmon MS, Frank ES, Gandhi S, Gupta R, Mates M, Moy B, Vandenberg T, Van Poznak CH. Use of Adjuvant Bisphosphonates and Other Bone-Modifying Agents in Breast Cancer: A Cancer Care Ontario and American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol 2017; 35:2062-2081. [PMID: 28618241 DOI: 10.1200/jco.2016.70.7257] [Citation(s) in RCA: 150] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Purpose To make recommendations regarding the use of bisphosphonates and other bone-modifying agents as adjuvant therapy for patients with breast cancer. Methods Cancer Care Ontario and ASCO convened a Working Group and Expert Panel to develop evidence-based recommendations informed by a systematic review of the literature. Results Adjuvant bisphosphonates were found to reduce bone recurrence and improve survival in postmenopausal patients with nonmetastatic breast cancer. In this guideline, postmenopausal includes patients with natural menopause or that induced by ovarian suppression or ablation. Absolute benefit is greater in patients who are at higher risk of recurrence, and almost all trials were conducted in patients who also received systemic therapy. Most studies evaluated zoledronic acid or clodronate, and data are extremely limited for other bisphosphonates. While denosumab was found to reduce fractures, long-term survival data are still required. Recommendations It is recommended that, if available, zoledronic acid (4 mg intravenously every 6 months) or clodronate (1,600 mg/d orally) be considered as adjuvant therapy for postmenopausal patients with breast cancer who are deemed candidates for adjuvant systemic therapy. Further research comparing different bone-modifying agents, doses, dosing intervals, and durations is required. Risk factors for osteonecrosis of the jaw and renal impairment should be assessed, and any pending dental or oral health problems should be dealt with prior to starting treatment. Data for adjuvant denosumab look promising but are currently insufficient to make any recommendation. Use of these agents to reduce fragility fractures in patients with low bone mineral density is beyond the scope of the guideline. Recommendations are not meant to restrict such use of bone-modifying agents in these situations. Additional information at www.asco.org/breast-cancer-adjuvant-bisphosphonates-guideline , www.asco.org/guidelineswiki , https://www.cancercareontario.ca/guidelines-advice/types-of-cancer/breast .
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Affiliation(s)
- Sukhbinder Dhesy-Thind
- Sukhbinder Dhesy-Thind, Juravinski Cancer Centre; Sukhbinder Dhesy-Thind and Glenn G. Fletcher, McMaster University, Hamilton, Ontario; Phillip S. Blanchette, Sunnybrook Odette Cancer Centre; Sonal Gandhi, Sunnybrook Health Sciences, Toronto, Ontario; Mark J. Clemons, The Ottawa Hospital Cancer Centre, Ottawa, Ontario; Rasna Gupta, Windsor Regional Cancer Program, Windsor, Ontario; Mihaela Mates, Kingston General Hospital, Kingston, Ontario; Ted Vandenberg, London Health Sciences Centre, London, Ontario, Canada; Melissa S. Dillmon, Harbin Clinic, Rome, GA; Elizabeth S. Frank, Lexington; Beverly Moy, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA; and Catherine H. Van Poznak, University of Michigan, Ann Arbor, MI
| | - Glenn G Fletcher
- Sukhbinder Dhesy-Thind, Juravinski Cancer Centre; Sukhbinder Dhesy-Thind and Glenn G. Fletcher, McMaster University, Hamilton, Ontario; Phillip S. Blanchette, Sunnybrook Odette Cancer Centre; Sonal Gandhi, Sunnybrook Health Sciences, Toronto, Ontario; Mark J. Clemons, The Ottawa Hospital Cancer Centre, Ottawa, Ontario; Rasna Gupta, Windsor Regional Cancer Program, Windsor, Ontario; Mihaela Mates, Kingston General Hospital, Kingston, Ontario; Ted Vandenberg, London Health Sciences Centre, London, Ontario, Canada; Melissa S. Dillmon, Harbin Clinic, Rome, GA; Elizabeth S. Frank, Lexington; Beverly Moy, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA; and Catherine H. Van Poznak, University of Michigan, Ann Arbor, MI
| | - Phillip S Blanchette
- Sukhbinder Dhesy-Thind, Juravinski Cancer Centre; Sukhbinder Dhesy-Thind and Glenn G. Fletcher, McMaster University, Hamilton, Ontario; Phillip S. Blanchette, Sunnybrook Odette Cancer Centre; Sonal Gandhi, Sunnybrook Health Sciences, Toronto, Ontario; Mark J. Clemons, The Ottawa Hospital Cancer Centre, Ottawa, Ontario; Rasna Gupta, Windsor Regional Cancer Program, Windsor, Ontario; Mihaela Mates, Kingston General Hospital, Kingston, Ontario; Ted Vandenberg, London Health Sciences Centre, London, Ontario, Canada; Melissa S. Dillmon, Harbin Clinic, Rome, GA; Elizabeth S. Frank, Lexington; Beverly Moy, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA; and Catherine H. Van Poznak, University of Michigan, Ann Arbor, MI
| | - Mark J Clemons
- Sukhbinder Dhesy-Thind, Juravinski Cancer Centre; Sukhbinder Dhesy-Thind and Glenn G. Fletcher, McMaster University, Hamilton, Ontario; Phillip S. Blanchette, Sunnybrook Odette Cancer Centre; Sonal Gandhi, Sunnybrook Health Sciences, Toronto, Ontario; Mark J. Clemons, The Ottawa Hospital Cancer Centre, Ottawa, Ontario; Rasna Gupta, Windsor Regional Cancer Program, Windsor, Ontario; Mihaela Mates, Kingston General Hospital, Kingston, Ontario; Ted Vandenberg, London Health Sciences Centre, London, Ontario, Canada; Melissa S. Dillmon, Harbin Clinic, Rome, GA; Elizabeth S. Frank, Lexington; Beverly Moy, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA; and Catherine H. Van Poznak, University of Michigan, Ann Arbor, MI
| | - Melissa S Dillmon
- Sukhbinder Dhesy-Thind, Juravinski Cancer Centre; Sukhbinder Dhesy-Thind and Glenn G. Fletcher, McMaster University, Hamilton, Ontario; Phillip S. Blanchette, Sunnybrook Odette Cancer Centre; Sonal Gandhi, Sunnybrook Health Sciences, Toronto, Ontario; Mark J. Clemons, The Ottawa Hospital Cancer Centre, Ottawa, Ontario; Rasna Gupta, Windsor Regional Cancer Program, Windsor, Ontario; Mihaela Mates, Kingston General Hospital, Kingston, Ontario; Ted Vandenberg, London Health Sciences Centre, London, Ontario, Canada; Melissa S. Dillmon, Harbin Clinic, Rome, GA; Elizabeth S. Frank, Lexington; Beverly Moy, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA; and Catherine H. Van Poznak, University of Michigan, Ann Arbor, MI
| | - Elizabeth S Frank
- Sukhbinder Dhesy-Thind, Juravinski Cancer Centre; Sukhbinder Dhesy-Thind and Glenn G. Fletcher, McMaster University, Hamilton, Ontario; Phillip S. Blanchette, Sunnybrook Odette Cancer Centre; Sonal Gandhi, Sunnybrook Health Sciences, Toronto, Ontario; Mark J. Clemons, The Ottawa Hospital Cancer Centre, Ottawa, Ontario; Rasna Gupta, Windsor Regional Cancer Program, Windsor, Ontario; Mihaela Mates, Kingston General Hospital, Kingston, Ontario; Ted Vandenberg, London Health Sciences Centre, London, Ontario, Canada; Melissa S. Dillmon, Harbin Clinic, Rome, GA; Elizabeth S. Frank, Lexington; Beverly Moy, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA; and Catherine H. Van Poznak, University of Michigan, Ann Arbor, MI
| | - Sonal Gandhi
- Sukhbinder Dhesy-Thind, Juravinski Cancer Centre; Sukhbinder Dhesy-Thind and Glenn G. Fletcher, McMaster University, Hamilton, Ontario; Phillip S. Blanchette, Sunnybrook Odette Cancer Centre; Sonal Gandhi, Sunnybrook Health Sciences, Toronto, Ontario; Mark J. Clemons, The Ottawa Hospital Cancer Centre, Ottawa, Ontario; Rasna Gupta, Windsor Regional Cancer Program, Windsor, Ontario; Mihaela Mates, Kingston General Hospital, Kingston, Ontario; Ted Vandenberg, London Health Sciences Centre, London, Ontario, Canada; Melissa S. Dillmon, Harbin Clinic, Rome, GA; Elizabeth S. Frank, Lexington; Beverly Moy, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA; and Catherine H. Van Poznak, University of Michigan, Ann Arbor, MI
| | - Rasna Gupta
- Sukhbinder Dhesy-Thind, Juravinski Cancer Centre; Sukhbinder Dhesy-Thind and Glenn G. Fletcher, McMaster University, Hamilton, Ontario; Phillip S. Blanchette, Sunnybrook Odette Cancer Centre; Sonal Gandhi, Sunnybrook Health Sciences, Toronto, Ontario; Mark J. Clemons, The Ottawa Hospital Cancer Centre, Ottawa, Ontario; Rasna Gupta, Windsor Regional Cancer Program, Windsor, Ontario; Mihaela Mates, Kingston General Hospital, Kingston, Ontario; Ted Vandenberg, London Health Sciences Centre, London, Ontario, Canada; Melissa S. Dillmon, Harbin Clinic, Rome, GA; Elizabeth S. Frank, Lexington; Beverly Moy, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA; and Catherine H. Van Poznak, University of Michigan, Ann Arbor, MI
| | - Mihaela Mates
- Sukhbinder Dhesy-Thind, Juravinski Cancer Centre; Sukhbinder Dhesy-Thind and Glenn G. Fletcher, McMaster University, Hamilton, Ontario; Phillip S. Blanchette, Sunnybrook Odette Cancer Centre; Sonal Gandhi, Sunnybrook Health Sciences, Toronto, Ontario; Mark J. Clemons, The Ottawa Hospital Cancer Centre, Ottawa, Ontario; Rasna Gupta, Windsor Regional Cancer Program, Windsor, Ontario; Mihaela Mates, Kingston General Hospital, Kingston, Ontario; Ted Vandenberg, London Health Sciences Centre, London, Ontario, Canada; Melissa S. Dillmon, Harbin Clinic, Rome, GA; Elizabeth S. Frank, Lexington; Beverly Moy, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA; and Catherine H. Van Poznak, University of Michigan, Ann Arbor, MI
| | - Beverly Moy
- Sukhbinder Dhesy-Thind, Juravinski Cancer Centre; Sukhbinder Dhesy-Thind and Glenn G. Fletcher, McMaster University, Hamilton, Ontario; Phillip S. Blanchette, Sunnybrook Odette Cancer Centre; Sonal Gandhi, Sunnybrook Health Sciences, Toronto, Ontario; Mark J. Clemons, The Ottawa Hospital Cancer Centre, Ottawa, Ontario; Rasna Gupta, Windsor Regional Cancer Program, Windsor, Ontario; Mihaela Mates, Kingston General Hospital, Kingston, Ontario; Ted Vandenberg, London Health Sciences Centre, London, Ontario, Canada; Melissa S. Dillmon, Harbin Clinic, Rome, GA; Elizabeth S. Frank, Lexington; Beverly Moy, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA; and Catherine H. Van Poznak, University of Michigan, Ann Arbor, MI
| | - Ted Vandenberg
- Sukhbinder Dhesy-Thind, Juravinski Cancer Centre; Sukhbinder Dhesy-Thind and Glenn G. Fletcher, McMaster University, Hamilton, Ontario; Phillip S. Blanchette, Sunnybrook Odette Cancer Centre; Sonal Gandhi, Sunnybrook Health Sciences, Toronto, Ontario; Mark J. Clemons, The Ottawa Hospital Cancer Centre, Ottawa, Ontario; Rasna Gupta, Windsor Regional Cancer Program, Windsor, Ontario; Mihaela Mates, Kingston General Hospital, Kingston, Ontario; Ted Vandenberg, London Health Sciences Centre, London, Ontario, Canada; Melissa S. Dillmon, Harbin Clinic, Rome, GA; Elizabeth S. Frank, Lexington; Beverly Moy, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA; and Catherine H. Van Poznak, University of Michigan, Ann Arbor, MI
| | - Catherine H Van Poznak
- Sukhbinder Dhesy-Thind, Juravinski Cancer Centre; Sukhbinder Dhesy-Thind and Glenn G. Fletcher, McMaster University, Hamilton, Ontario; Phillip S. Blanchette, Sunnybrook Odette Cancer Centre; Sonal Gandhi, Sunnybrook Health Sciences, Toronto, Ontario; Mark J. Clemons, The Ottawa Hospital Cancer Centre, Ottawa, Ontario; Rasna Gupta, Windsor Regional Cancer Program, Windsor, Ontario; Mihaela Mates, Kingston General Hospital, Kingston, Ontario; Ted Vandenberg, London Health Sciences Centre, London, Ontario, Canada; Melissa S. Dillmon, Harbin Clinic, Rome, GA; Elizabeth S. Frank, Lexington; Beverly Moy, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA; and Catherine H. Van Poznak, University of Michigan, Ann Arbor, MI
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Bone Modifier Use as Adjuvant Therapy for Early Breast Cancer. Curr Oncol Rep 2017; 19:15. [DOI: 10.1007/s11912-017-0577-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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147
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Updates on the role of receptor activator of nuclear factor κB/receptor activator of nuclear factor κB ligand/osteoprotegerin pathway in breast cancer risk and treatment. Curr Opin Obstet Gynecol 2017; 29:4-11. [DOI: 10.1097/gco.0000000000000333] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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148
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Pulido C, Vendrell I, Ferreira AR, Casimiro S, Mansinho A, Alho I, Costa L. Bone metastasis risk factors in breast cancer. Ecancermedicalscience 2017; 11:715. [PMID: 28194227 PMCID: PMC5295847 DOI: 10.3332/ecancer.2017.715] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Indexed: 12/25/2022] Open
Abstract
Bone is the single most frequent site for bone metastasis in breast cancer patients. Patients with bone-only metastasis have a fairly good prognosis when compared with patients with visceral disease. Nevertheless, cancer-induced bone disease carries an important risk of developing skeletal related events that impact quality of life (QoL). It is therefore particularly important to stratify patients according to their risk of developing bone metastasis. In this context, several risk factors have been studied, including demographic, clinicopathological, genetic, and metabolic factors. Most of them show conflicting or non-definitive associations and are not validated for clinical use. Nonetheless, tumour intrinsic subtype is widely accepted as a major risk factor for bone metastasis development and luminal breast cancer carries an increased risk for bone disease. Other factors such as gene signatures, expression of specific cytokines (such as bone sialoprotein and bone morphogenetic protein 7) or components of the extracellular matrix (like bone crosslinked C-telopeptide) might also influence the development of bone metastasis. Knowledge of risk factors related with bone disease is of paramount importance as it might be a prediction tool for triggering the use of targeted agents and allow for better patient selection for future clinical trials.
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Affiliation(s)
- Catarina Pulido
- Serviço de Oncologia Médica, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Avenida Professor Egas Moniz, 1649-035 Lisboa, Portugal; These authors contributed equally to this work
| | - Inês Vendrell
- Serviço de Oncologia Médica, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Avenida Professor Egas Moniz, 1649-035 Lisboa, Portugal; These authors contributed equally to this work
| | - Arlindo R Ferreira
- Serviço de Oncologia Médica, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Avenida Professor Egas Moniz, 1649-035 Lisboa, Portugal; Luis Costa Lab, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
| | - Sandra Casimiro
- Luis Costa Lab, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
| | - André Mansinho
- Serviço de Oncologia Médica, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Avenida Professor Egas Moniz, 1649-035 Lisboa, Portugal
| | - Irina Alho
- Luis Costa Lab, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
| | - Luís Costa
- Serviço de Oncologia Médica, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Avenida Professor Egas Moniz, 1649-035 Lisboa, Portugal; Luis Costa Lab, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
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Melisko ME, Gradishar WJ, Moy B. Issues in Breast Cancer Survivorship: Optimal Care, Bone Health, and Lifestyle Modifications. Am Soc Clin Oncol Educ Book 2017; 35:e22-9. [PMID: 27249727 DOI: 10.1200/edbk_159203] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
There are an estimated 3.1 million survivors of breast cancer in the United States. The predominant reasons for this substantially large population are that breast cancer is the most common noncutaneous malignancy among women and that 5-year survival rates after breast cancer treatment are approximately 90%. These patients have many medical considerations, including the need to monitor for disease recurrence and to manage complications of their previous cancer treatments. Most patients remain at risk indefinitely for local and systemic recurrences of their breast cancers and have an increased risk of developing contralateral new primary breast cancers. Therefore, optimizing care for this patient population is critical to the overall health care landscape in the United States. Here, we summarize survivorship care delivery and its challenges, the optimization of bone health in breast cancer survivors, and opportunities for risk reduction through lifestyle modifications.
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Affiliation(s)
- Michelle E Melisko
- From the UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Massachusetts General Hospital Cancer Center, Boston, MA
| | - William J Gradishar
- From the UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Massachusetts General Hospital Cancer Center, Boston, MA
| | - Beverly Moy
- From the UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Massachusetts General Hospital Cancer Center, Boston, MA
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Tauro M, Shay G, Sansil SS, Laghezza A, Tortorella P, Neuger AM, Soliman H, Lynch CC. Bone-Seeking Matrix Metalloproteinase-2 Inhibitors Prevent Bone Metastatic Breast Cancer Growth. Mol Cancer Ther 2017; 16:494-505. [PMID: 28069877 DOI: 10.1158/1535-7163.mct-16-0315-t] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 12/05/2016] [Accepted: 12/07/2016] [Indexed: 11/16/2022]
Abstract
Bone metastasis is common during breast cancer progression. Matrix metalloproteinase-2 (MMP-2) is significantly associated with aggressive breast cancer and poorer overall survival. In bone, tumor- or host-derived MMP-2 contributes to breast cancer growth and does so by processing substrates, including type I collagen and TGFβ latency proteins. These data provide strong rationale for the application of MMP-2 inhibitors to treat the disease. However, in vivo, MMP-2 is systemically expressed. Therefore, to overcome potential toxicities noted with previous broad-spectrum MMP inhibitors (MMPIs), we used highly selective bisphosphonic-based MMP-2 inhibitors (BMMPIs) that allowed for specific bone targeting. In vitro, BMMPIs affected the viability of breast cancer cell lines and osteoclast precursors, but not osteoblasts. In vivo, we demonstrated using two bone metastatic models (PyMT-R221A and 4T1) that BMMPI treatment significantly reduced tumor growth and tumor-associated bone destruction. In addition, BMMPIs are superior in promoting tumor apoptosis compared with the standard-of-care bisphosphonate, zoledronate. We demonstrated MMP-2-selective inhibition in the bone microenvironment using specific and broad-spectrum MMP probes. Furthermore, compared with zoledronate, BMMPI-treated mice had significantly lower levels of TGFβ signaling and MMP-generated type I collagen carboxy-terminal fragments. Taken together, our data show the feasibility of selective inhibition of MMPs in the bone metastatic breast cancer microenvironment. We posit that BMMPIs could be easily translated to the clinical setting for the treatment of bone metastases given the well-tolerated nature of bisphosphonates. Mol Cancer Ther; 16(3); 494-505. ©2017 AACR.
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Affiliation(s)
- Marilena Tauro
- Tumor Biology Department, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Gemma Shay
- Tumor Biology Department, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Samer S Sansil
- Translational Research Core and, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Antonio Laghezza
- Department of Pharmacy-Pharmaceutical Sciences, University of Bari "A. Moro", Bari, Italy
| | - Paolo Tortorella
- Department of Pharmacy-Pharmaceutical Sciences, University of Bari "A. Moro", Bari, Italy
| | - Anthony M Neuger
- Translational Research Core and, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Hatem Soliman
- Department of Women's Oncology and Experimental Therapeutics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Conor C Lynch
- Tumor Biology Department, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.
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