1
|
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.
Collapse
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
| |
Collapse
|
2
|
Curtin M, Piggott RP, Murphy EP, Munigangaiah S, Baker JF, McCabe JP, Devitt A. Spinal Metastatic Disease: A Review of the Role of the Multidisciplinary Team. Orthop Surg 2017; 9:145-151. [PMID: 28544780 DOI: 10.1111/os.12334] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 03/02/2017] [Indexed: 12/16/2022] Open
Abstract
Historically, a simple approach centered on palliation was applicable to the majority of patients with metastatic spinal disease. With advances in diagnosis and treatment, a more complicated algorithm has devolved requiring a multidisciplinary approach with institutional commitment and support. We performed a database review including pertinent articles exploring the multidisciplinary management of spinal metastatic disease. The wide variation in clinical presentation and tumor response to treatment necessitates a multidisciplinary approach that integrates the diagnosis and treatment of the cancer, symptom management, and rehabilitation for optimal care of patients with spinal metastases. Advances in the field of radiology have led to earlier and more focused diagnosis of spinal metastasis and acts to guide therapy. Advances in surgical techniques, neurophysiologic monitoring, and anesthetic expertise have allowed surgeons to perform more extensive procedures leading to improved outcomes and reduced morbidity. Radiation oncology input that is essential as external beam radiation therapy can provide significant pain relief. Non-operative measures may include bisphosphonate infusions, management of complications (e.g. hypercalcemia of malignancy), monoclonal antibody infusions, and chemotherapy if indicated in the treatment of the primary malignancy. Input from psychology services is necessary to address the biopsychosocial ramifications of spinal metastasis. Allied health professionals in the form of physiotherapists, social workers, and dieticians also contribute in maximizing patients' quality of life and well-being.
Collapse
Affiliation(s)
- Mark Curtin
- Department of Trauma and Orthopaedic Surgery, University College Hospital Galway, Saolta Hospital Group, Galway, Ireland
| | - Robert P Piggott
- Department of Trauma and Orthopaedic Surgery, University College Hospital Galway, Saolta Hospital Group, Galway, Ireland
| | - Evelyn P Murphy
- Department of Trauma and Orthopaedic Surgery, University College Hospital Galway, Saolta Hospital Group, Galway, Ireland
| | - Sudarshan Munigangaiah
- Department of Trauma and Orthopaedic Surgery, University College Hospital Galway, Saolta Hospital Group, Galway, Ireland
| | - Joseph F Baker
- Department of Trauma and Orthopaedic Surgery, University College Hospital Galway, Saolta Hospital Group, Galway, Ireland
| | - John P McCabe
- Department of Trauma and Orthopaedic Surgery, University College Hospital Galway, Saolta Hospital Group, Galway, Ireland
| | - Aiden Devitt
- Department of Trauma and Orthopaedic Surgery, University College Hospital Galway, Saolta Hospital Group, Galway, Ireland
| |
Collapse
|
3
|
Treatment and Prevention of Bone Metastases from Breast Cancer: A Comprehensive Review of Evidence for Clinical Practice. J Clin Med 2014; 3:1-24. [PMID: 26237249 PMCID: PMC4449670 DOI: 10.3390/jcm3010001] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Revised: 12/11/2013] [Accepted: 12/16/2013] [Indexed: 12/25/2022] Open
Abstract
Bone is the most common site of metastasis from breast cancer. Bone metastases from breast cancer are associated with skeletal-related events (SREs) including pathological fractures, spinal cord compression, surgery and radiotherapy to bone, as well as bone pain and hypercalcemia, leading to impaired mobility and reduced quality of life. Greater understanding of the pathophysiology of bone metastases has led to the discovery and clinical utility of bone-targeted agents such as bisphosphonates and the receptor activator of nuclear factor kappa-B ligand (RANK-L) antibody, denosumab. Both are now a routine part of the treatment of breast cancer bone metastases to reduce SREs. With regards to prevention, there is no evidence that oral bisphosphonates can prevent bone metastases in advanced breast cancer without skeletal involvement. Several phase III clinical trials have evaluated bisphosphonates as adjuvant therapy in early breast cancer to prevent bone metastases. The current published data do not support the routine use of bisphosphonates in unselected patients with early breast cancer for metastasis prevention. However, significant benefit of adjuvant bisphosphonates has been consistently observed in the postmenopausal or ovarian suppression subgroup across multiple clinical trials, which raises the hypothesis that its greatest anti-tumor effect is in a low estrogen microenvironment. An individual patient data meta-analysis will be required to confirm survival benefit in this setting. This review summarizes the key evidence for current clinical practice and future directions.
Collapse
|
4
|
Src inhibitors in the treatment of metastatic bone disease: rationale and clinical data. ACTA ACUST UNITED AC 2011; 1:1695-1706. [PMID: 22384312 DOI: 10.4155/cli.11.150] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Src is a nonreceptor tyrosine kinase essential for the activation of osteoclasts, the cells that degrade bone. Src also regulates normal cell functions, cancer cell growth and metastasis to organs, including bone where tumor cells induce bone destruction by osteoclasts. Src inhibitors prevent bone destruction and tumor cell growth in animal models of metastatic bone disease, and some are being investigated in clinical trials, particularly in patients with prostate cancer, which has high bone metastatic potential. Here, we review how Src regulates osteoclast formation, activation and survival and the results of preclinical and clinical trials of Src inhibitors, which show some promise in inhibiting the effects of tumor cells on the skeleton.
Collapse
|
5
|
Wong MH, Pavlakis N. Optimal management of bone metastases in breast cancer patients. BREAST CANCER (DOVE MEDICAL PRESS) 2011; 3:35-60. [PMID: 24367175 PMCID: PMC3846421 DOI: 10.2147/bctt.s6655] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Bone metastasis in breast cancer is a significant clinical problem. It not only indicates incurable disease with a guarded prognosis, but is also associated with skeletal-related morbidities including bone pain, pathological fractures, spinal cord compression, and hypercalcemia. In recent years, the mechanism of bone metastasis has been further elucidated. Bone metastasis involves a vicious cycle of close interaction between the tumor and the bone microenvironment. In patients with bone metastases, the goal of management is to prevent further skeletal-related events, manage complications, reduce bone pain, and improve quality of life. Bisphosphonates are a proven therapy for the above indications. Recently, a drug of a different class, the RANK ligand antibody, denosumab, has been shown to reduce skeletal-related events more than the bisphosphonate, zoledronic acid. Other strategies of clinical value may include surgery, radiotherapy, radiopharmaceuticals, and, of course, effective systemic therapy. In early breast cancer, bisphosphonates may have an antitumor effect and prevent both bone and non-bone metastases. Whilst two important Phase III trials with conflicting results have led to controversy in this topic, final results from these and other key Phase III trials must still be awaited before a firm conclusion can be drawn about the use of bisphosphonates in this setting. Advances in bone markers, predictive biomarkers, multi-imaging modalities, and the introduction of novel agents have ushered in a new era of proactive management for bone metastases in breast cancer.
Collapse
Affiliation(s)
- MH Wong
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - N Pavlakis
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, NSW, Australia
| |
Collapse
|