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Back J, Nguyen MN, Li L, Lee S, Lee I, Chen F, Gillinov L, Chung YH, Alder KD, Kwon HK, Yu KE, Dussik CM, Hao Z, Flores MJ, Kim Y, Ibe IK, Munger AM, Seo SW, Lee FY. Inflammatory conversion of quiescent osteoblasts by metastatic breast cancer cells through pERK1/2 aggravates cancer-induced bone destruction. Bone Res 2021; 9:43. [PMID: 34588427 PMCID: PMC8481290 DOI: 10.1038/s41413-021-00158-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 03/09/2021] [Accepted: 03/28/2021] [Indexed: 02/08/2023] Open
Abstract
Disruption of bone homeostasis caused by metastatic osteolytic breast cancer cells increases inflammatory osteolysis and decreases bone formation, thereby predisposing patients to pathological fracture and cancer growth. Alteration of osteoblast function induces skeletal diseases due to the disruption of bone homeostasis. We observed increased activation of pERK1/2 in osteolytic breast cancer cells and osteoblasts in human pathological specimens with aggressive osteolytic breast cancer metastases. We confirmed that osteolytic breast cancers with high expression of pERK1/2 disrupt bone homeostasis via osteoblastic ERK1/2 activation at the bone-breast cancer interface. The process of inflammatory osteolysis modulates ERK1/2 activation in osteoblasts and breast cancer cells through dominant-negative MEK1 expression and constitutively active MEK1 expression to promote cancer growth within bone. Trametinib, an FDA-approved MEK inhibitor, not only reduced breast cancer-induced bone destruction but also dramatically reduced cancer growth in bone by inhibiting the inflammatory skeletal microenvironment. Taken together, these findings suggest that ERK1/2 activation in both breast cancer cells and osteoblasts is required for osteolytic breast cancer-induced inflammatory osteolysis and that ERK1/2 pathway inhibitors may represent a promising adjuvant therapy for patients with aggressive osteolytic breast cancers by altering the shared cancer and bone microenvironment.
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Affiliation(s)
- Jungho Back
- grid.47100.320000000419368710Department of Orthopædics & Rehabilitation, Yale University, School of Medicine, New Haven, CT USA
| | - Minh Nam Nguyen
- grid.47100.320000000419368710Department of Orthopædics & Rehabilitation, Yale University, School of Medicine, New Haven, CT USA ,grid.444808.40000 0001 2037 434XResearch Center for Genetics and Reproductive Health, School of Medicine, Vietnam National University Ho Chi Minh City, Linh Trung Ward, Thu Duc District, Ho Chi Minh City, Vietnam
| | - Lu Li
- grid.47100.320000000419368710Department of Orthopædics & Rehabilitation, Yale University, School of Medicine, New Haven, CT USA ,grid.415869.7Department of Rehabilitation Medicine, Renji Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Saelim Lee
- grid.47100.320000000419368710Department of Orthopædics & Rehabilitation, Yale University, School of Medicine, New Haven, CT USA ,grid.411982.70000 0001 0705 4288College of Medicine, Dankook University, Cheonan, Republic of Korea
| | - Inkyu Lee
- grid.47100.320000000419368710Department of Orthopædics & Rehabilitation, Yale University, School of Medicine, New Haven, CT USA ,grid.254224.70000 0001 0789 9563Department of Life Science, Chung-Ang University, Seoul, Republic of Korea
| | - Fancheng Chen
- grid.47100.320000000419368710Department of Orthopædics & Rehabilitation, Yale University, School of Medicine, New Haven, CT USA ,grid.11841.3d0000 0004 0619 8943Shanghai Medical College, Fudan University, Shanghai City, China
| | - Lauren Gillinov
- grid.47100.320000000419368710Department of Orthopædics & Rehabilitation, Yale University, School of Medicine, New Haven, CT USA
| | - Yeon-Ho Chung
- grid.47100.320000000419368710Department of Orthopædics & Rehabilitation, Yale University, School of Medicine, New Haven, CT USA
| | - Kareme D. Alder
- grid.47100.320000000419368710Department of Orthopædics & Rehabilitation, Yale University, School of Medicine, New Haven, CT USA
| | - Hyuk-Kwon Kwon
- grid.47100.320000000419368710Department of Orthopædics & Rehabilitation, Yale University, School of Medicine, New Haven, CT USA
| | - Kristin E. Yu
- grid.47100.320000000419368710Department of Orthopædics & Rehabilitation, Yale University, School of Medicine, New Haven, CT USA
| | - Christopher M. Dussik
- grid.47100.320000000419368710Department of Orthopædics & Rehabilitation, Yale University, School of Medicine, New Haven, CT USA
| | - Zichen Hao
- grid.47100.320000000419368710Department of Orthopædics & Rehabilitation, Yale University, School of Medicine, New Haven, CT USA ,grid.411525.60000 0004 0369 1599Department of Emergency & Trauma, Changhai Hospital, Navy Medical University, Shanghai, China
| | - Michael J. Flores
- grid.47100.320000000419368710Department of Orthopædics & Rehabilitation, Yale University, School of Medicine, New Haven, CT USA
| | - Yoseph Kim
- grid.21107.350000 0001 2171 9311Biomedical Engineering, Johns Hopkins University, Baltimore, MD USA
| | - Izuchukwu K. Ibe
- grid.47100.320000000419368710Department of Orthopædics & Rehabilitation, Yale University, School of Medicine, New Haven, CT USA
| | - Alana M. Munger
- grid.47100.320000000419368710Department of Orthopædics & Rehabilitation, Yale University, School of Medicine, New Haven, CT USA
| | - Sung Wook Seo
- grid.414964.a0000 0001 0640 5613Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Gangnam-gu Republic of Korea
| | - Francis Y. Lee
- grid.47100.320000000419368710Department of Orthopædics & Rehabilitation, Yale University, School of Medicine, New Haven, CT USA
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Association of Performance Status and Pain in Metastatic Bone Pain Management in the Spanish Clinical Setting. Adv Ther 2017; 34:136-147. [PMID: 27873236 DOI: 10.1007/s12325-016-0435-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 10/05/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Bone metastasis is the most common cause of cancer-related pain, and metastatic bone pain (MBP) is not only severe but also progressive in many patients. The aim of this study was to investigate the association between pain management and performance status in patients with metastatic bone cancer in the Spanish clinical setting. METHODS A 3-month follow-up prospective, epidemiologic, multicenter study was conducted in 579 patients to assess the evolution of their performance, the impact of pain control on sleep and functionality, and the degree of pain control according to analgesic treatment. RESULTS In patients with MBP, Eastern Cooperative Oncology Group (ECOG) status (1.5 ± 0.7-1.3 ± 0.7 and 1.3 ± 0.8; p < 0.001) and pain (6.5 ± 1.4-2.8 ± 1.9 and 2.1 ± 1.9; p < 0.001) improved significantly from baseline to months 1 and 3, as did functionality and sleep, after a treatment change consisting of increasing the administration of opioids. Evolution of ECOG and pain were closely related. ECOG and pain outcomes were significantly more favorable in patients treated with opioids versus non-opioid treatment, and in patients who did not need rescue medication versus those who did. CONCLUSIONS MBP is currently poorly managed in Spain. ECOG improvement is closely and directly related to pain management in MBP. Opioid treatment and a lack of requirements for rescue medication are associated with better ECOG and pain outcomes in MBP patients. FUNDING Mundipharma Pharmaceuticals S.L.
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Kreul SM, Sorger JI, Rajamanickam VP, Heiner JP. Updated Outcomes of Prophylactic Femoral Fixation. Orthopedics 2016; 39:e346-52. [PMID: 26913761 DOI: 10.3928/01477447-20160222-08] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 09/01/2015] [Indexed: 02/03/2023]
Abstract
Despite an increasing number of patients with metastatic bone disease (MBD), minimal data exist regarding outcomes of patients undergoing prophylactic femoral fixation for MBD when compared with other frequently performed orthopedic operations, such as hemiarthroplasty of the femur. The authors performed a retrospective database review evaluating these procedures due to similar operative times and patient populations and also reviewed common comorbidities such as body mass index (BMI). The goal was to provide updated results of prophylactic femoral fixation and evaluate whether certain patient risk factors (eg, BMI) altered 30-day survival for patients with MBD. The authors reviewed 1849 patients with and without MBD treated by prophylactic fixation and hemiarthroplasty from 2006 to 2011 identified in the American College of Surgeons National Surgical Quality Improvement Program database. There were no significant differences in complications between patients undergoing surgical treatment for impending or actual femoral fracture. In addition, there were no differences between the 217 patients with MBD in either the hemiarthroplasty or prophylactic fixation groups because the rate of death within 30 days postoperatively was 5.56% and 3.30%, respectively (P=.526). When comparing BMI, obese patients had higher rates of wound infection, and underweight patients were more likely to develop pneumonia or die within 30 days postoperatively. Patients with impending femur fractures benefit from prophylactic fixation and perform as well in the short term as patients undergoing hemiarthroplasty. Certain BMI categories (underweight or obese) contributed to poorer outcomes. These findings provide updated information for discussing risks and benefits with surgical candidates.
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von Moos R, Body JJ, Egerdie B, Stopeck A, Brown J, Fallowfield L, Patrick DL, Cleeland C, Damyanov D, Palazzo FS, Marx G, Zhou Y, Braun A, Balakumaran A, Qian Y. Pain and analgesic use associated with skeletal-related events in patients with advanced cancer and bone metastases. Support Care Cancer 2016; 24:1327-37. [PMID: 26329397 PMCID: PMC4729787 DOI: 10.1007/s00520-015-2908-1] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 08/16/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE Bone metastases secondary to solid tumors increase the risk of skeletal-related events (SREs), including the occurrence of pathological fracture (PF), radiation to bone (RB), surgery to bone (SB), and spinal cord compression (SCC). The aim of this study was to evaluate the impact of SREs on patients' pain, analgesic use, and pain interference with daily functioning. METHODS Data were combined from patients with solid tumors and bone metastases who received denosumab or zoledronic acid across three identically designed phase 3 trials (N = 5543). Pain severity (worst pain) and pain interference were assessed using the Brief Pain Inventory at baseline and each monthly visit. Analgesic use was quantified using the Analgesic Quantification Algorithm. RESULTS The proportion of patients with moderate/severe pain and strong opioid use generally increased in the 6 months preceding an SRE and remained elevated, while they remained relatively consistent over time in patients without an SRE. Regression analysis indicated that all SRE types were significantly associated with an increased risk of progression to moderate/severe pain and strong opioid use. PF, RB, and SCC were associated with significantly greater risk of pain interference overall. Results were similar for pain interference with emotional well-being. All SRE types were associated with significantly greater risk of pain interference with physical function. CONCLUSIONS SREs are associated with increased pain and analgesic use in patients with bone metastases. Treatments that prevent SREs may decrease pain and the need for opioid analgesics and reduce the impact of pain on daily functioning.
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Affiliation(s)
- Roger von Moos
- Kantonsspital Graubünden, Loëstrasse 170, CH-7000, Chur, Switzerland.
| | | | | | - Alison Stopeck
- Arizona Cancer Center, University of Arizona, Tucson, AZ, USA
| | - Janet Brown
- Experimental Cancer Medicine Centre, Weston Park Hospital, University of Sheffield, Sheffield, UK
| | | | | | - Charles Cleeland
- University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Danail Damyanov
- National Hospital for Treatment in Oncology, Sofia, Bulgaria
| | | | - Gavin Marx
- Sydney Adventist Hospital, Wahroonga, Sydney, Australia
| | | | | | | | - Yi Qian
- Amgen, Inc., Thousand Oaks, CA, USA
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Hendriks LEL, Hermans BCM, van den Beuken-van Everdingen MHJ, Hochstenbag MMH, Dingemans AMC. Effect of Bisphosphonates, Denosumab, and Radioisotopes on Bone Pain and Quality of Life in Patients with Non-Small Cell Lung Cancer and Bone Metastases: A Systematic Review. J Thorac Oncol 2015; 11:155-73. [PMID: 26718881 DOI: 10.1016/j.jtho.2015.10.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 10/01/2015] [Accepted: 10/08/2015] [Indexed: 12/25/2022]
Abstract
Bone metastases are common in patients with non-small cell lung cancer (NSCLC), often causing pain and a decrease in quality of life (QoL). The effect of bone-targeted agents is evaluated by reduction in skeletal-related events in which neither pain nor QoL are included. Radioisotopes can be administered for more diffuse bone pain that is not eligible for palliative radiotherapy. The evidence that bone-targeted agents relieve pain or improve QoL is not solid. We performed a systematic review of the effect of bone-targeted agents on pain and QoL in patients with NSCLC. Our systematic literature search included original articles or abstracts reporting on bisphosphonates, denosumab, or radioisotopes or combinations thereof in patients with bone metastases (≥5 patients with NSCLC), with pain, QoL, or both serving as the primary or secondary end point. Of the twenty-five eligible studies, 13 examined bisphosphonates (one also examined denosumab) and 12 dealt with radioisotopes. None of the randomized studies on bisphosphonates or denosumab evaluated pain and QoL as the primary end point. In the single-arm studies of bisphosphonates a decrease in pain or analgesic consumption was found for 38% to 77% of patients. QoL was included in five of 13 studies, but improvement was found in only two. No high-level evidence that bisphosphonates or denosumab reduce pain or improve QoL was found. Although the data are limited, radioisotopes seem to reduce pain with a rapid onset of action and duration of response of 1 to 3 months. The evidence that bisphosphonates or denosumab reduce or prevent pain in patients with NSCLC and bone metastases or that they have an influence on QoL is very weak. Radioisotopes can be used to reduce diffuse pain, although there is no high-level evidence supporting such use.
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Affiliation(s)
- Lizza E L Hendriks
- Department of Pulmonary Diseases, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Bregtje C M Hermans
- Department of Pulmonary Diseases, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Monique M H Hochstenbag
- Department of Pulmonary Diseases, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Anne-Marie C Dingemans
- Department of Pulmonary Diseases, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
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Ford JA, Jones R, Elders A, Mulatero C, Royle P, Sharma P, Stewart F, Todd R, Mowatt G. Denosumab for treatment of bone metastases secondary to solid tumours: systematic review and network meta-analysis. Eur J Cancer 2012; 49:416-30. [PMID: 22906748 DOI: 10.1016/j.ejca.2012.07.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Revised: 07/02/2012] [Accepted: 07/10/2012] [Indexed: 10/28/2022]
Abstract
AIM To evaluate the evidence for denosumab for the treatment of bone metastases secondary to solid tumours and, using a network meta-analysis, indirectly compare denosumab with bisphosphonates and best supportive care. DATA SOURCES MEDLINE (1948 to April 2011), EMBASE (1980 to March 2011), Cochrane Library (all sections) (issue 1, 2011) and Web of Science with Conference Proceedings (1970 to May 2011) and additional meeting abstracts (2010 and 2011) were searched. STUDY ELIGIBILITY, PARTICIPANTS AND INTERVENTIONS: Only randomised controlled trials assessing denosumab, bisphosphonates or best supportive care in patients with bone metastases from any solid tumour were included. SYNTHESIS Direct evidence comparing denosumab and zoledronic acid was assessed for breast cancer, prostate cancer and other solid tumours. Denosumab was compared with pamidronate and best supportive care through a network meta-analysis for each tumour type. The primary outcomes were time to first skeletal related event (SRE) and time to first and subsequent SRE. Secondary outcomes were skeletal morbidity rate, pain, quality of life (QoL) and overall survival. RESULTS Denosumab was found to be more effective in delaying the time to first SRE and reducing the risk of first and subsequent SRE compared to zoledronic acid, placebo and pamidronate. In breast and prostate cancer, denosumab was effective in reducing skeletal morbidity rate compared with placebo. The lack of published data on pain and QoL meant that firm conclusions could not be made. Denosumab did not appear to have an affect on overall survival. LIMITATIONS Network meta-analyses are subject to uncertainties and potential biases. CONCLUSIONS Denosumab is effective in preventing SRE, but the effect on pain and QoL is unclear.
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Affiliation(s)
- John A Ford
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK.
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