Practical Considerations in Bone Metastases in Breast Cancer
Practical Considerations in Bone Metastases in Breast Cancer
European Oncology Review 2005
Published: October 2008
Published: October 2008
Progress in the management of breast cancer through the use of endocrine therapy and chemotherapy has proven beneficial for patients with relapsed metastatic disease, and the adjuvant use of such therapy has resulted in reduced relapse rates and improved survival for patients with operable breast cancer. This, combined with recent evidence of the benefits of aromatase inhibitor therapy in both early and advanced breast cancer, will continue to have a substantial impact on the evolving management of this disease. The mechanism of actions of both chemotherapy and endocrine therapy is based on the direct effect of the drugs on the proliferation and survival of cancer cells.
A completely different additional approach is to use drugs with an effect on a normal host tissue, which could control the development of the cancer. For example, bone, a common site for the development of metastases, is a good potential target because the development of bone metastases depends on the ability of cancer cells to produce substances that activate osteoclasts causing osteolysis, thereby facilitating the growth of the cancer in the bone. The activated osteoclasts in turn release growth factors that are able to promote cancer cell proliferation in the bone marrow, further encouraging metastatic development in the bones and possibly elsewhere in the body.1 Use of agents that inhibit osteoclasts could prevent the development of bone metastases and this benefit would be added to the proven benefits of anticancer agents such as endocrine therapy and chemotherapy.2
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