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Hussain M, Khan F, Al Hadidi S. The use of bone-modifying agents in multiple myeloma. Blood Rev 2023; 57:100999. [PMID: 36050125 DOI: 10.1016/j.blre.2022.100999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 01/28/2023]
Abstract
Multiple myeloma is a hematological neoplasm characterized by abnormal proliferation of plasma cells in the bone marrow and is usually associated with increased bone pain and skeletal-related events such as pathological fracture and/or spinal cord compression. Myeloma bone disease results in changes in the bone-marrow microenvironment evidenced by increased osteoclastic activity and/or decreased osteoblastic activity, which negatively affect quality of life. Treatment of myeloma bone disease includes bisphosphonates or denosumab (bone-modifying agents). These agents do not induce the formation of new bone or repair existing bone damage, but they can decrease bone pain and the risk of pathological fracture. While these agents improve quality of life, it is not known whether they improve overall survival. This review focuses on different classes of bone-modifying agents, their mechanisms of action, time of initiation, duration of therapy, and potential survival benefits.
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Affiliation(s)
- Munawwar Hussain
- Myeloma Center, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Fatima Khan
- Department of Hematology Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Samer Al Hadidi
- Myeloma Center, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America.
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Soundia A, Hadaya D, Chau Y, Gkouveris I, Bezouglaia O, Dry S, Pirih F, Aghaloo T, Tetradis S. Local RANKL delivery improves socket healing in bisphosphonate treated rats. Bone 2021; 148:115945. [PMID: 33836308 PMCID: PMC9396533 DOI: 10.1016/j.bone.2021.115945] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 04/01/2021] [Accepted: 04/02/2021] [Indexed: 01/15/2023]
Abstract
Medication related osteonecrosis of the Jaws (MRONJ) is a severe complication of antiresorptive and anti-angiogenic medications. Osteoclast inhibition is central in MRONJ pathogenesis. Here, we investigated if local application of RANKL (a key molecule in osteoclast activation) could enhance osteoclast generation and improve extraction socket healing in the presence of bisphosphonates. Thirty Wistar-Han rats received one saline or 66 μg/kg zoledronate (ZA) i.p. dose before surgery. A week later, mandibular molars were extracted bilaterally. Collagen tapes infused with water or RANKL were placed in the extraction sockets of 60 hemimandibles of veh (veh/RANKL-, veh/RANKL+) or ZA treated rats (ZA/RANKL-, ZA/RANKL+). Rats were euthanized 3 or 12 days after surgery. Animals euthanized at 12 days received two additional veh or ZA injections. Clinical, radiographic and histologic assessments were performed. Visually, at the 3-day timepoint, no sockets demonstrated complete healing. At the 12-day timepoint, sockets of veh/RANKL- and veh/RANKL+ rats showed intact mucosa, while mucosal defects were noted in ZA/RANKL- rats. Importantly, ZA/RANKL+ sockets showed absence of bone exposure. RANKL delivery increased bone healing in the ZA/RANKL+ sites 12 days after extraction compared to the ZA/RANKL- sites. Histologically, at the 3-day timepoint, ZA/RANKL- sockets demonstrated extensive bone exposure and osteonecrosis. In contrast, ZA/RANKL+ rats showed granulation tissue coverage and significantly reduced osteonecrosis, similar to the veh groups. Importantly, in the ZA/RANKL+ group, osteoclasts attached to the bone surface and osteoclast numbers were higher compared to ZA/RANKL- sites. At the 12-day timepoint, persistent osteonecrosis and bone exposure were detected in the sockets of ZA/RANKL- animals. Contrary, ZA/RANKL+ rats demonstrated socket epithelialization and reduced osteonecrosis. Significantly more total and bony attached osteoclasts persisted in the ZA/RANKL+ vs the ZA/RANKL- group. We present a novel approach towards improving socket healing, in the presence of ZA, by enhancing osteoclastic numbers and attachment through local RANKL application. Our approach is clinically applicable and could improve treatment outcomes of patients on high-dose ZA therapy.
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Affiliation(s)
- Akrivoula Soundia
- Division of Diagnostic and Surgical Sciences, UCLA School of Dentistry, Los Angeles, CA, USA
| | - Danny Hadaya
- Division of Diagnostic and Surgical Sciences, UCLA School of Dentistry, Los Angeles, CA, USA
| | - Yee Chau
- Division of Diagnostic and Surgical Sciences, UCLA School of Dentistry, Los Angeles, CA, USA
| | - Ioannis Gkouveris
- Department of Oral and Maxillofacial Pathology and Medicine, School of Dentistry, National and Kapodistrian University of Athens, Greece
| | - Olga Bezouglaia
- Division of Diagnostic and Surgical Sciences, UCLA School of Dentistry, Los Angeles, CA, USA
| | - Sarah Dry
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Flavia Pirih
- Division of Constitutive and Regenerative Sciences, UCLA School of Dentistry, Los Angeles, CA, USA
| | - Tara Aghaloo
- Division of Diagnostic and Surgical Sciences, UCLA School of Dentistry, Los Angeles, CA, USA.
| | - Sotirios Tetradis
- Division of Diagnostic and Surgical Sciences, UCLA School of Dentistry, Los Angeles, CA, USA.
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3
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D'Oronzo S, Wood S, Brown JE. "The use of bisphosphonates to treat skeletal complications in solid tumours". Bone 2021; 147:115907. [PMID: 33676057 DOI: 10.1016/j.bone.2021.115907] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 02/26/2021] [Accepted: 02/27/2021] [Indexed: 10/22/2022]
Abstract
The skeleton is the most common site of secondary disease in breast cancer and prostate cancer, with up to 80% of patients with advanced disease developing bone metastases (BM). The proportion is also substantial in advanced lung cancer (20%-40%). Because of the high prevalence of cancers of the breast, prostate and lung, these cancers account for more than 80% of cases of metastatic bone disease occurring in solid tumours. Metastatic bone disease is associated with greatly increased bone resorption by osteoclasts, leading to moderate to severe pain and other skeletal complications, with major impact on quality of life (QoL). Skeletal Related Events (SREs) have been defined as: pathological long bone or vertebral fractures; spinal cord compression; need for radiation for pain relief or to prevent fracture/spinal cord compression, need for surgery to bone and hypercalcaemia. More recently, Symptomatic Skeletal Events (SSEs) have been defined to monitor QoL. Although there are currently no curative treatments for metastatic bone disease, patients with breast or prostate cancer and BM are now surviving for several years and sometimes longer, and prevention of SREs is the key aim to optimization of QoL. Since their discovery 50 years ago and their introduction more than 30 years ago into the field of metastatic bone disease, a range of oral and intravenous bisphosphonate drugs have made a major contribution to prevention of SREs. Large trials have clearly demonstrated the clinical value of different bisphosphonate-based drugs (including the oral drugs ibandronate and clodronate and intravenous agents such as zoledronate and pamidronate), in treatment of hypercalcaemia of malignancy and the reduction of SREs and SSEs in a range of cancers. Despite the success of denosumab in reducing osteolysis, bisphosphonates also remain mainstay drugs for treatment of metastatic bone disease. Recognizing the 50th Anniversary of the discovery of bisphosphonates, this review focuses on their continuing value in BM treatment and their future potential, for example in providing a bone-targeting vehicle for cytotoxic drugs.
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Affiliation(s)
- S D'Oronzo
- Medical Oncology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, P.za Giulio Cesare, 11, 70124 Bari, Italy
| | - S Wood
- Department of Oncology and Metabolism, The Medical School, Beech Hill Road, Sheffield, South Yorkshire S10 2RX, UK.
| | - J E Brown
- Academic Unit of Clinical Oncology, Department of Oncology and Metabolism, University of Sheffield, Weston Park Hospital, Whitham Rd, Broomhill, Sheffield S10 2SJ, UK
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4
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Raghu Subramanian C, Talluri S, Mullangi S, Lekkala MR, Moftakhar B. Review of Bone Modifying Agents in Metastatic Breast Cancer. Cureus 2021; 13:e13332. [PMID: 33738175 PMCID: PMC7960030 DOI: 10.7759/cureus.13332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2021] [Indexed: 11/17/2022] Open
Abstract
Bone is the most common site for distant metastases in breast cancer and can cause significant morbidity and mortality. Bone modifying agents (BMAs) that include bisphosphonates (BPAs) and denosumab help in decreasing and delaying skeletal-related events (SREs) associated with metastatic breast cancer. BPAs approved for use by the Food and Drug Administration (FDA) in bone metastases (BM) in the United States are pamidronate and zolendronic acid, while clodronate and ibandronate are licensed for use in other countries. Current American Society of Clinical Oncology (ASCO) guidelines recommend denosumab 120 mg subcutaneously every four weeks, or zolendronic acid 4 mg every four weeks or every 12 weeks, or intravenous pamidronate 90 mg every four weeks. Current guidelines do not recommend one BMA over another, however, zolendronic acid and denosumab were the most commonly used BMAs in population-based studies. Side effects of BMAs include acute phase reactions, hypocalcemia, nephrotoxicity, osteonecrosis of jaw, etc. While other side effects are common with both BPAs and denosumab, the latter has less nephrotoxic potential and is preferred for use in patients with renal failure. Current ASCO guidelines recommend continuing BMAs indefinitely, however, in clinical practice, this decision needs to be individualized, especially since there is no data on the impact of long-term use of BMAs. Further studies would need to be developed to develop an algorithm of SRE risk assessment and to determine which patients would benefit from BMAs.
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Affiliation(s)
| | - Swapna Talluri
- Department of Medicine, Guthrie Robert Packer Hospital, Sayre, USA
| | | | - Manidhar R Lekkala
- Department of Hematology/Oncology, James P Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, USA
| | - Bahar Moftakhar
- Department of Hematology/Oncology, James P Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, USA
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Spine and Non-spine Bone Metastases - Current Controversies and Future Direction. Clin Oncol (R Coll Radiol) 2020; 32:728-744. [PMID: 32747153 DOI: 10.1016/j.clon.2020.07.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/21/2020] [Accepted: 07/10/2020] [Indexed: 02/06/2023]
Abstract
Bone is a common site of metastases in advanced cancers. The main symptom is pain, which increases morbidity and reduces quality of life. The treatment of bone metastases needs a multidisciplinary approach, with the main aim of relieving pain and improving quality of life. Apart from systemic anticancer therapy (hormonal therapy, chemotherapy or immunotherapy), there are several therapeutic options available to achieve palliation, including analgesics, surgery, local radiotherapy, bone-seeking radioisotopes and bone-modifying agents. Long-term use of non-steroidal analgesics and opiates is associated with significant side-effects, and tachyphylaxis. Radiotherapy is effective mainly in localised disease sites. Bone-targeting radionuclides are useful in patients with multiple metastatic lesions. Bone-modifying agents are beneficial in reducing skeletal-related events. This overview focuses on the role of surgery, including minimally invasive treatments, conventional radiotherapy in spinal and non-spinal bone metastases, bone-targeting radionuclides and bone-modifying agents in achieving palliation. We present the clinical data and their associated toxicity. Recent advances are also discussed.
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Southcott D, Awan A, Ghate K, Clemons M, Fernandes R. Practical update for the use of bone-targeted agents in patients with bone metastases from metastatic breast cancer or castration-resistant prostate cancer. Curr Oncol 2020; 27:220-224. [PMID: 32905286 PMCID: PMC7467800 DOI: 10.3747/co.27.6631] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Bone metastases are a significant source of morbidity and mortality for patients with breast and prostate cancer. In this review, we discuss key practical themes regarding the use of bone-targeted agents (btas) such as bisphosphonates and denosumab for managing bony metastatic disease. The btas both delay the onset and reduce the incidence of skeletal-related events (sres), defined as any or all of a need for radiation therapy or surgery to bone, pathologic fracture, spinal cord compression, or hypercalcemia of malignancy. They have more modest benefits for pain and other quality-of-life measures. Regardless of the benefits of btas, it should always be remembered that the palliative management of metastatic bone disease is multimodal and multidisciplinary. The collaboration of all disciplines is essential for optimal patient care. Special consideration is given to these key questions: ■ What are btas, and what is their efficacy?■ What are their common toxicities?■ When should they be initiated?■ How do we choose the appropriate bta?■ What is the appropriate dose, schedule, and duration of btas?
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Affiliation(s)
- D Southcott
- Division of Medical Oncology, Department of Oncology, Schulich School of Medicine and Dentistry, Western University, London, ON
| | - A Awan
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital and University of Ottawa, Ottawa
| | - K Ghate
- Department of Medicine, Division of Medical Oncology, Oakville Trafalgar Memorial Hospital, Oakville, ON
| | - M Clemons
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital and University of Ottawa, Ottawa
| | - R Fernandes
- Division of Medical Oncology, Department of Oncology, Schulich School of Medicine and Dentistry, Western University, London, ON
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7
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Immune system and bone microenvironment: rationale for targeted cancer therapies. Oncotarget 2020; 11:480-487. [PMID: 32064051 PMCID: PMC6996902 DOI: 10.18632/oncotarget.27439] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 12/31/2019] [Indexed: 12/20/2022] Open
Abstract
Osteoimmunology was coined about twenty years ago to identify a strict cross talk between bone niche and immune system both in physiological and pathological activities, including cancer. Several molecules are involved in the complex interaction between bone niche, immune and cancer cells. The Receptor Activator of NF-kB (RANK)/RANK Ligand (RANKL/Osteoprotegerin (OPG) pathway plays a crucial role in bone cells/cancer interactions with subsequently immune system control failure, bone destruction, inhibition of effect and metastasis outcome. The bidirectional cross talk between bone and immune system could became a potential target for anticancer drugs. Several studies evidenced a direct anticancer role with improved survival of bone-targeted therapies such as bisphosphonates and RANKL antagonist Denosumab. Conversely, initial data evidenced a possible anti-bone resorption effect of systemic anticancer drugs through and immunomodulation activity, i.e. new generation antiandrogens (Abiraterone) in prostate cancer. All data could open a future rationale of combined bone, immunologic and targeted therapies in cancer treatment.
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8
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Wang X, Yamauchi K, Mitsunaga T. A review on osteoclast diseases and osteoclastogenesis inhibitors recently developed from natural resources. Fitoterapia 2020; 142:104482. [PMID: 31954740 DOI: 10.1016/j.fitote.2020.104482] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 01/09/2020] [Accepted: 01/14/2020] [Indexed: 12/14/2022]
Abstract
Natural products have been investigated as potential candidates of novel therapeutics and play a crucial role in advanced medicinal drugs. Natural resources, including local medicinal plants (especially folk medicinal plants), animals, bacteria, and fungi have been used for more than a century, and are precious gifts from nature, providing potential medicines with high safety. Osteoclast-related diseases, such as osteoporosis, rheumatoid arthritis, Paget's disease, osteoclastoma, and periprosthetic osteolysis, are currently the most common reasons for bone inflammation, pain and fractures, resulting in low quality of life. However, the curative effects of current therapeutic drugs for these osteoclast-related diseases are limited, and long-term treatment is needed. Further, in severe cases, surgical treatments are necessary, which may cause unaffordable expenses and subsequent influences such as neuralgia, mental stress, and even development of cancer. Thus, safer inhibitors and potential drugs with enhanced curative effects and quick relief are needed to treat patients with osteoclast diseases. This review aims to introduce the main osteoclast-related diseases and some of the recently developed naturally sourced inhibitors against osteoclastogenesis, also it is desired to attract people's attention on using widely available natural resources for the evolution of new types of osteoclast inhibitors with minimal or no side-effects upon long-term treatments.
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Affiliation(s)
- Xiaoyu Wang
- The United Graduate School of Agricultural Science, Gifu University, Gifu, Japan
| | - Kosei Yamauchi
- The United Graduate School of Agricultural Science, Gifu University, Gifu, Japan
| | - Tohru Mitsunaga
- The United Graduate School of Agricultural Science, Gifu University, Gifu, Japan.
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Yang YL, Xiang ZJ, Yang JH, Wang WJ, Xiang RL. The incidence and relative risk of adverse events in patients treated with bisphosphonate therapy for breast cancer: a systematic review and meta-analysis. Ther Adv Med Oncol 2019; 11:1758835919855235. [PMID: 31217825 PMCID: PMC6558551 DOI: 10.1177/1758835919855235] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 05/08/2019] [Indexed: 12/18/2022] Open
Abstract
Background: Adjuvant bisphosphonates reduce the rate of breast cancer recurrence in the
bone and improve breast cancer survival. However, the risk of adverse events
associated with bisphosphonate therapy for breast cancer remains poorly
defined. Methods: A literature search was conducted using the PubMed, EMBASE, Cochrane and Web
of Science libraries. Risk ratio (RR) was calculated to evaluate the adverse
events of the meta-analytic results. Osteonecrosis of the jaw (ONJ)
incidence was calculated using the random effect model (D+L pooled) for
meta-analysis. Results: A total of 47 studies comprising 20,607 patients were included; 23 randomized
controlled studies (RCTs) provided data of adverse events for bisphosphonate
therapy versus without bisphosphonates. Bisphosphonates
were significantly associated with influenza-like illness (RR = 4.52),
fatigue (RR = 1.08), fever (RR = 1.82), dyspepsia (RR = 1.25), anorexia
(RR = 1.29), and urinary tract infection (RR = 1.32). No differences were
observed in other adverse events. We combined the incidence of ONJ in 24
retrospective studies to analyze the incidence of ONJ using bisphosphonates.
The pooled probability of ONJ toxicity in the bisphosphonates group was
2%. Conclusions: Bisphosphonates were significantly associated with influenza-like illness,
fatigue, fever, dyspepsia, anorexia, and urinary tract infection.
Furthermore, bisphosphonates increase the risk of ONJ toxicity.
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Affiliation(s)
- Yan-Li Yang
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | | | | | | | - Ruo-Lan Xiang
- Department of Physiology and Pathophysiology, Peking University School of Basic Medical Sciences, Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, and Beijing Key Laboratory of Cardiovascular Receptors Research, China
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Toller CS, Charlesworth S, Mihalyo M, Howard P, Wilcock A. Bisphosphonates: AHFS 92:24. J Pain Symptom Manage 2019; 57:1018-1030. [PMID: 30738144 DOI: 10.1016/j.jpainsymman.2019.01.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 01/29/2019] [Indexed: 11/20/2022]
Abstract
Therapeutic Reviews aim to provide essential independent information for health professionals about drugs used in palliative and hospice care. Additional content is available via www.medicinescomplete.com. The series editors welcome feedback on the articles (hq@palliativedrugs.com).
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Affiliation(s)
- Claire Stark Toller
- Countess Mountbatten House (C.S.T.), University Hospital Southampton; Pharmaceutical Press (S.C.), London, United Kingdom; Mylan School of Pharmacy (M.M.), Duquesne University, Pittsburgh, Pennsylvania, USA; Mountbatten Hospice (P.H.), Isle of Wight, United Kingdom; and University of Nottingham (A.W.), Nottingham, United Kingdom
| | - Sarah Charlesworth
- Countess Mountbatten House (C.S.T.), University Hospital Southampton; Pharmaceutical Press (S.C.), London, United Kingdom; Mylan School of Pharmacy (M.M.), Duquesne University, Pittsburgh, Pennsylvania, USA; Mountbatten Hospice (P.H.), Isle of Wight, United Kingdom; and University of Nottingham (A.W.), Nottingham, United Kingdom
| | - Mary Mihalyo
- Countess Mountbatten House (C.S.T.), University Hospital Southampton; Pharmaceutical Press (S.C.), London, United Kingdom; Mylan School of Pharmacy (M.M.), Duquesne University, Pittsburgh, Pennsylvania, USA; Mountbatten Hospice (P.H.), Isle of Wight, United Kingdom; and University of Nottingham (A.W.), Nottingham, United Kingdom
| | - Paul Howard
- Countess Mountbatten House (C.S.T.), University Hospital Southampton; Pharmaceutical Press (S.C.), London, United Kingdom; Mylan School of Pharmacy (M.M.), Duquesne University, Pittsburgh, Pennsylvania, USA; Mountbatten Hospice (P.H.), Isle of Wight, United Kingdom; and University of Nottingham (A.W.), Nottingham, United Kingdom
| | - Andrew Wilcock
- Countess Mountbatten House (C.S.T.), University Hospital Southampton; Pharmaceutical Press (S.C.), London, United Kingdom; Mylan School of Pharmacy (M.M.), Duquesne University, Pittsburgh, Pennsylvania, USA; Mountbatten Hospice (P.H.), Isle of Wight, United Kingdom; and University of Nottingham (A.W.), Nottingham, United Kingdom.
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11
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Bonetto R, Tallet A, Mélot A, Calderon B, Barlesi F. [The management of bone metastasis]. Bull Cancer 2017; 104:585-592. [PMID: 28391985 DOI: 10.1016/j.bulcan.2017.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 02/05/2017] [Accepted: 02/10/2017] [Indexed: 12/25/2022]
Abstract
Bone metastasis are the most common cause of pain related to cancer, reducing patients' quality of life, and sometimes threatening their life-expectancy. Their management has to be pluridisciplinary, because of all the therapeutic options and the diversity of bone metastasis locations. The aim of this work is to propose a rational decisional algorithm for the treatment strategy of these secondary locations. Anti-resorbtive drugs with systemic action, surgery, conventional or stereotactic radiation therapy, and new techniques of interventional radiology are options that could be used separately or combined. They have shown benefits on symptomatic treatment, improving quality of life. Their indications vary according to the tumor site (short vs. long bones, carrier vs. non-carrier bones), the symptomatology (pain, neurologic symptoms), and the presence of complications (most of all fractures). The diverse presentations lead us to define this decisional algorithm, to guide the practice, while giving the maximal benefit to each patient according to each metastasis.
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Affiliation(s)
- Rémi Bonetto
- Aix-Marseille université, Assistance publique-Hôpitaux de Marseille, service d'oncologie multidisciplinaire et innovations thérapeutiques, 13920 Marseille cedex 15, France.
| | - Agnès Tallet
- Institut Paoli-Calmettes, département d'oncologie-radiothérapie, 232, boulevard Sainte-Marguerite, 13273 Marseille cedex 09, France
| | - Anthony Mélot
- Aix-Marseille université, hôpital Nord, service de neurochirurgie, chemin des Bourrely, 13915 Marseille cedex 20, France
| | - Benoît Calderon
- Aix-Marseille université, Assistance publique-Hôpitaux de Marseille, CHU La Timone, service de radiothérapie, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France
| | - Fabrice Barlesi
- Aix-Marseille université, Assistance publique-Hôpitaux de Marseille, service d'oncologie multidisciplinaire et innovations thérapeutiques, 13920 Marseille cedex 15, France; Aix-Marseille université, faculté de médecine, centre de recherche en oncologie biologique et oncopharmacologie, Inserm U911, 13005 Marseille, France
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12
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A multicenter, retrospective epidemiologic survey of the clinical features and management of bone metastatic disease in China. CHINESE JOURNAL OF CANCER 2016; 35:40. [PMID: 27112196 PMCID: PMC4845386 DOI: 10.1186/s40880-016-0102-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Accepted: 01/26/2016] [Indexed: 11/16/2022]
Abstract
Background Bone metastases are common in patients with advanced cancer. Bisphosphonates (BPs) could prevent or delay the development of skeleton-related events (SREs). The present study aimed to identify the clinical features of and treatment strategies for Chinese patients with bone metastases. Methods Consecutive cancer patients who had bone metastases and received BP treatment were enrolled. A questionnaire was developed to collect the patients’ clinical data, as well as information on the diagnosis and management of bone metastases. Physicians’ awareness of the guidelines and knowledge of the application of BP were also assessed. Results A total of 3223 patients with lung cancer (36.5%), breast cancer (30.9%), prostate cancer (8.5%), and gastrointestinal cancer (5.7%) were included in this study. The sites of bone metastases were the thoracic spine (56.0 %), lumbar spine (47.1%), ribs (32.6%), and pelvis (23.2%). The SRE frequency was the highest in patients with multiple myeloma (36.6%), followed by those with lung cancer (25.9%), breast cancer (20.2%), prostate cancer (18.2%), and gastrointestinal cancer (17.3%). Irradiation to the bone was the most frequent SRE (58% in lung cancer patients, 45% in breast cancer patients, and 48% in prostate cancer patients). Our survey also showed that 45.5% of patients received BP within 3 months after their diagnosis of bone metastases, whereas the remaining 54.5% of patients did not receive BP treatment until at least 3 months after their diagnosis of bone metastases. The SRE frequency in the former group was significantly lower than that in the latter group (4.0% vs. 42.3%, P < 0.05). In patients with more than 6 months of continuous BP treatment, the mean time to the first SRE was significantly longer than that in patients with less than 6 months of continuous BP treatment (7.2 vs. 3.4 months, P < 0.05). In addition, 12.2% of the physicians were not aware of the efficacy of BP in preventing and delaying SRE. Only half (52.3%) of the physicians agreed that the BP treatment should persist for at least 6 months unless it was intolerable. Conclusions Our study suggested that prompt and persistent BP treatment was associated with a reduced risk of SREs. However, our survey also revealed that the proper application of BP was not as common as expected in China. Electronic supplementary material The online version of this article (doi:10.1186/s40880-016-0102-6) contains supplementary material, which is available to authorized users.
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13
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Koizumi H, Suzuki H, Ikezaki S, Ohbuchi T, Hashida K, Sakai A. Osteoclasts are not activated in middle ear cholesteatoma. J Bone Miner Metab 2016; 34:193-200. [PMID: 25796629 DOI: 10.1007/s00774-015-0655-5] [Citation(s) in RCA: 10] [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: 07/23/2014] [Accepted: 01/12/2015] [Indexed: 10/23/2022]
Abstract
It is unclear whether osteoclasts are present and activated in cholesteatomas. We explored the expression of messenger RNA (mRNA) for osteoclast biomarkers and regulating factors in middle ear cholesteatomas to elucidate the level of osteoclast activity in this disease. Bone powder was collected from 14 patients with cholesteatomatous and noncholesteatomatous chronic otitis media during tympanomastoidectomy, separately from cortical bone of the mastoid (clean bone powder), from bone neighboring cholesteatoma (cholesteatomatous bone powder), and from bone of the air cells and antrum of noncholesteatomatous chronic otitis media patients (noncholesteatomatous bone powder). The samples collected were soaked in TRIzol reagent, and total RNA was extracted and purified by the acid guanidinium thiocyanate-phenol-chloroform method, followed by the use of magnetic bead technology. The sample was then subjected to quantitative reverse transcription polymerase chain reaction for receptor activator of nuclear factor κB (RANK), tartrate-resistant acid phosphatase (TRAP), cathepsin K (CTSK), osteoclast-associated receptor (OSCAR), calcitonin receptor (CALCR), matrix metalloproteinase 9 (MMP9), receptor activator of nuclear factor κB ligand (RANKL), and osteoprotegerin (OPG). There was no significant difference in the expression of TRAP, CTSK, OSCAR, CALCR, MMP9, or OPG among the clean, cholesteatomatous, and noncholesteatomatous bone powder. On the other hand, the expression of RANK and RANKL was significantly lower in the cholesteatomatous bone powder than in the noncholesteatomatous bone powder (P = 0.003 and P = 0.028, respectively). The RANKL mRNA/OPG mRNA ratio did not differ among the three samples. These results indicate that osteoclasts are unlikely to be activated in cholesteatomas. Bone resorption mechanisms not mediated by osteoclasts may need to be reappraised in cholesteatoma research in future studies.
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Affiliation(s)
- Hiroki Koizumi
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Hideaki Suzuki
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan.
| | - Shoji Ikezaki
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Toyoaki Ohbuchi
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Koichi Hashida
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Akinori Sakai
- Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
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Geng CJ, Liang Q, Zhong JH, Zhu M, Meng FY, Wu N, Liang R, Yuan BY. Ibandronate to treat skeletal-related events and bone pain in metastatic bone disease or multiple myeloma: a meta-analysis of randomised clinical trials. BMJ Open 2015; 5:e007258. [PMID: 26038356 PMCID: PMC4458633 DOI: 10.1136/bmjopen-2014-007258] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Randomised controlled trials (RCTs) have given contradictory results about the efficacy and safety of ibandronate in treating metastatic bone disease (MBD) or multiple myeloma. This review meta-analysed the literature to gain a more comprehensive picture. DESIGN Systematic review and meta-analysis of ibandronate compared with placebo or zoledronate. DATA SOURCES PubMed, EMBASE and the Cochrane Library databases were systematically searched to identify RCTs published up to March 2015 evaluating ibandronate to treat MBD or multiple myeloma. REVIEW METHOD 10 RCTs involving 3474 patients were included. Six RCTs were placebo-controlled and four compared ibandronate with zoledronate. The studies included in this review were mainly from European countries. RESULTS Intravenous ibandronate (6 mg) or oral drug (50 mg) decreased the risk of skeletal-related events compared to placebo (risk ratio (RR) 0.80, 95% CI 0.71 to 0.90, p=0.002). It also reduced the bone pain score below baseline significantly more than did placebo at 96 weeks (weighted mean difference -0.41, 95% CI -0.56 to -0.27, p<0.001). The incidence of diarrhoea, nausea and adverse renal events was similar between the ibandronate and placebo groups, but ibandronate was associated with greater risk of abdominal pain. Ibandronate was associated with similar risk of skeletal-related events as another bisphosphonate drug, zoledronate (RR 1.02, 95% CI 0.82 to 1.26, p=0.87). The incidence of nausea, jaw osteonecrosis and fatigue was similar for the two drugs, but the incidence of adverse renal events was significantly lower in the ibandronate group. CONCLUSIONS Ibandronate significantly reduces the incidence of skeletal-related events and bone pain in patients with MBD or multiple myeloma relative to placebo. It is associated with a similar incidence of skeletal-related events as zoledronate.
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Affiliation(s)
- Chun-Jing Geng
- Department of Anesthesiology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, People's Republic of China
| | - Qian Liang
- Postgraduate School of Guangxi Medical University, Nanning, People's Republic of China
| | - Jian-Hong Zhong
- Hepatobiliary Surgery Department, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, People's Republic of China
| | - Min Zhu
- Department of Anesthesiology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, People's Republic of China
| | - Fan-Ying Meng
- Department of Anesthesiology, Affiliated Hospital of Chifeng University, Inner Mongolia Autonomous Region,Nanning, People's Republic of China
| | - Ning Wu
- Department of Anesthesiology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, People's Republic of China
| | - Rui Liang
- Department of Anesthesiology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, People's Republic of China
| | - Bin-Yi Yuan
- Out-patient Department, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, People's Republic of China
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15
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Scarborough MT. CORR Insights ®: Intramedullary nailing of femoral diaphyseal metastases: is it necessary to protect the femoral neck? Clin Orthop Relat Res 2015; 473:1503-4. [PMID: 25537809 PMCID: PMC4353513 DOI: 10.1007/s11999-014-4114-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 12/12/2014] [Indexed: 01/31/2023]
Affiliation(s)
- Mark T. Scarborough
- Department of Orthopaedics and Rehabilitation, University of Florida, PO Box 112727, Gainesville, FL 32611 USA
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16
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Resolving cancer-stroma interfacial signalling and interventions with micropatterned tumour-stromal assays. Nat Commun 2014; 5:5662. [PMID: 25489927 PMCID: PMC4261930 DOI: 10.1038/ncomms6662] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 10/24/2014] [Indexed: 01/09/2023] Open
Abstract
Tumor-stromal interactions are a determining factor in cancer progression. In vivo, the interaction interface is associated with spatially-resolved distributions of cancer and stromal phenotypes. Here, we establish a micropatterned tumor-stromal assay (μTSA) with laser capture microdissection to control the location of co-cultured cells and analyze bulk and interfacial tumor-stromal signaling in driving cancer progression. μTSA reveals a spatial distribution of phenotypes in concordance with human estrogen receptor-positive (ER+) breast cancer samples, and heterogeneous drug activity relative to the tumor-stroma interface. Specifically, an unknown mechanism of reversine is shown in targeting tumor-stromal interfacial interactions using ER+ MCF-7 breast cancer and bone marrow-derived stromal cells. Reversine suppresses MCF-7 tumor growth and bone metastasis in vivo by reducing tumor stromalization including collagen deposition and recruitment of activated stromal cells. This study advocates μTSA as a platform for studying tumor microenvironmental interactions and cancer field effects with applications in drug discovery and development.
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17
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Criscitiello C, Viale G, Gelao L, Esposito A, De Laurentiis M, De Placido S, Santangelo M, Goldhirsch A, Curigliano G. Crosstalk between bone niche and immune system: osteoimmunology signaling as a potential target for cancer treatment. Cancer Treat Rev 2014; 41:61-8. [PMID: 25499997 DOI: 10.1016/j.ctrv.2014.12.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 11/26/2014] [Accepted: 12/01/2014] [Indexed: 01/08/2023]
Abstract
There is a well recognized link between the bone and the immune system and in recent years there has been a major effort to elucidate the multiple functions of the molecules expressed in both bone and immune cells. Several molecules that were initially identified and studied in the immune system have been shown to have essential functions also in the bone. An interdisciplinary field embracing immune and bone biology has been brought together and called "osteoimmunology". The co-regulation of the skeletal and immune systems strikingly exemplifies the extreme complexity of such an interaction. Their interdependency must be considered in designing therapeutic approaches for either of the two systems. In other words, it is necessary to think of the osteoimmune system as a complex physiological unit. Denosumab was originally introduced to specifically target bone resorption, but it is now under evaluation for its effect on the long term immune response. Similarly, our current and still growing knowledge of the intimate link between the immune system and bone will be beneficial for the safety of drugs targeting either of these integrated systems. Given the large number of molecules exerting functions on both the skeletal and immune systems, osteoimmunological understanding is becoming increasingly important. Both bone and immune systems are frequently disrupted in cancer; and they may be crucial in regulating tumor growth and progression. Some therapies - such as bisphosphonates and receptor activator of NF-κB ligand (RANKL) targeted drugs - that aim at reducing pathologic osteolysis in cancer may interact with the immune system, thus providing potential favorable effects on survival.
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Affiliation(s)
- Carmen Criscitiello
- Division of Experimental Therapeutics, Breast Cancer Program, Istituto Europeo di Oncologia, Via Ripamonti 435, 20133 Milano, Italy.
| | - Giulia Viale
- Division of Experimental Therapeutics, Breast Cancer Program, Istituto Europeo di Oncologia, Via Ripamonti 435, 20133 Milano, Italy
| | - Lucia Gelao
- Division of Experimental Therapeutics, Breast Cancer Program, Istituto Europeo di Oncologia, Via Ripamonti 435, 20133 Milano, Italy
| | - Angela Esposito
- Division of Experimental Therapeutics, Breast Cancer Program, Istituto Europeo di Oncologia, Via Ripamonti 435, 20133 Milano, Italy
| | - Michele De Laurentiis
- Department of Breast Oncology, National Cancer Institute "Fondazione Pascale", Naples, Italy
| | - Sabino De Placido
- Department of Endocrinology and Molecular and Clinical Oncology, University of Naples Federico II, Napoli, Italy
| | - Michele Santangelo
- Department of Advanced Medical Sciences, Operative Unit of General Surgery and Transplants, University of Naples Federico II, Napoli, Italy
| | - Aron Goldhirsch
- Division of Experimental Therapeutics, Breast Cancer Program, Istituto Europeo di Oncologia, Via Ripamonti 435, 20133 Milano, Italy
| | - Giuseppe Curigliano
- Division of Experimental Therapeutics, Breast Cancer Program, Istituto Europeo di Oncologia, Via Ripamonti 435, 20133 Milano, Italy
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18
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Erdogan B, Cicin I. Medical treatment of breast cancer bone metastasis: from bisphosphonates to targeted drugs. Asian Pac J Cancer Prev 2014; 15:1503-10. [PMID: 24641358 DOI: 10.7314/apjcp.2014.15.4.1503] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Breast cancer bone metastasis causing severe morbidity is commonly encountered in daily clinical practice. It causes pain, pathologic fractures, spinal cord and other nerve compression syndromes and life threatening hypercalcemia. Breast cancer metastasizes to bone through complicated steps in which numerous molecules play roles. Metastatic cells disrupt normal bone turnover and create a vicious cycle to which treatment efforts should be directed. Bisphosphonates have been used safely for more than two decades. As a group they delay time to first skeletal related event and reduce pain, but do not prevent development of bone metastasis in patients with no bone metastasis, and also do not prolong survival. The receptor activator for nuclear factor κB ligand inhibitor denosumab delays time to first skeletal related event and reduces the skeletal morbidity rate. Radionuclides are another treatment option for bone pain. New targeted therapies and radionuclides are still under investigation. In this review we will focus on mechanisms of bone metastasis and its medical treatment in breast cancer patients.
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Affiliation(s)
- Bulent Erdogan
- Departments of Medical Oncology, Agri State Hospital, Turkey E-mail :
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19
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Fang J, Xu Q. Differences of osteoblastic bone metastases and osteolytic bone metastases in clinical features and molecular characteristics. Clin Transl Oncol 2014; 17:173-9. [DOI: 10.1007/s12094-014-1247-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 09/30/2014] [Indexed: 12/12/2022]
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