More than 50% of patients with advanced breast or prostate cancer have identifiable bone metastasis, and 30% to 40% of patients with non–small-cell lung cancer ultimately develop metastases to bone.[1,2]
A new class of cancer alpha-pharmaceuticals is approaching the marketplace, one built around the basis of radiotherapy itself. An isotope of radium, the element discovered more than a century ago by Pierre and Marie Curie, is the cornerstone of this new class of radiopharmaceuticals.
The addition of zoledronic acid (Zometa) increases overall survival in lung cancer patients with bone metastases, according to researchers at Aristotle University of Thessaloniki and G. Papanikolaou Hospital in Greece.
The goal of palliative radiotherapy is to treat symptoms as rapidly and efficiently as possible, with the fewest side effects. For many years, pain medication, radiotherapy, and surgery were the only tools available for the treatment of bone metastases. This has changed significantly over the past 15 years. New systemic agents, including bisphosphonates such as zoledronic acid (Reclast, Zometa), are available to prevent the development of new lesions, strengthen the bone, and improve symptoms. In addition, targeted treatments directed at achieving tumor ablation now include radiofrequency ablation and stereotactic body radiation therapy (SBRT).
The authors have provided a concise review of stereotactic body radiosurgery (SBRS) in the treatment of mainly spinal/paraspinal metastases. This technique was primarily developed to treat spinal metastases in the reirradiation scenario given that treatment alternatives are limited for these patients and that—in the setting of advanced metastatic disease—surgical decompression is often not a suitable option.
Bone metastases are a common feature of many solid cancers, especially those originating from the prostate, breast, lung, kidney, melanoma, and other sites. Up to 80% of patients with these cancers will develop painful bony disease during the course of their disease.
Zoledronic Acid Reduces Recurrence in Women With Early-Stage Breast Cancer Undergoing Hormonal Therapy
Researchers report that zoledronic acid (Zometa), a drug used to treat bone metastases and recently approved to treat osteoporosis, also lowers the risk of breast cancer recurrence in premenopausal patients with early-stage disease who have undergone surgery and are receiving ovarian suppression and hormone therapy. All women in this multicenter phase III trial had cancer that was estrogen-receptor– or progesterone-receptor–positive. The study was presented at the ASCO plenary session by lead author Michael Gant, md, professor of surgery at the Medical University of Vienna and the president of the Austrian Breast and Colorectal Cancer Study Group, or ABCSG (abstract LBA4).
The aromatase inhibitors (AIs) anastrozole (Arimidex), letrozole (Femara), and exemestane (Aromasin) are significantly more effective than the selective estrogen-receptor modulator (SERM) tamoxifen in preventing recurrence in estrogen receptor-positive early breast cancer. Aromatase inhibitors are likely to replace SERMs as first-line adjuvant therapy for many patients. However, AIs are associated with significantly more osteoporotic fractures and greater bone mineral loss. As antiresorptive agents, oral and intravenous bisphosphonates such as alendronate (Fosamax), risedronate (Actonel), ibandronate (Boniva), pamidronate (Aredia), and zoledronic acid (Zometa) have efficacy in preventing postmenopausal osteoporosis, cancer treatment-related bone loss, or skeletal complications of metastatic disease. Clinical practice guidelines recommend baseline and annual follow-up bone density monitoring for all patients initiating AI therapy. Bisphosphonate therapy should be prescribed for patients with osteoporosis (T score < -2.5) and considered on an individual basis for those with osteopenia (T score < -1). Modifiable lifestyle behaviors including adequate calcium and vitamin D intake, weight-bearing exercise, and smoking cessation should be addressed. Adverse events associated with bisphosphonates include gastrointestinal toxicity, renal toxicity, and osteonecrosis of the jaw. These safety concerns should be balanced with the potential of bisphosphonates to minimize or prevent the debilitating effects of AI-associated bone loss in patients with early, hormone receptor-positive breast cancer.
SALT LAKE CITY—A single fraction of 8 Gy of radiation therapy is as efficacious as 30 Gy delivered in 10 fractions for palliation of painful bone metastases and causes less acute toxicity, reported William F. Hartsell, MD, at the 45th Annual Meeting of the American Society for Therapeutic Radiology and Oncology (plenary session, abstract 1).
In this issue, Ramaswamy and Shapiro
provide another excellent review
of the recent literature on the
role of bisphosphonates in the management
of bone metastases from
breast cancer and selected other cancers.
Bisphosphonates and bone metastases
have been the subject of
numerous similar publications. In a
quick Medline search of papers published
since January 2002, I found 12
different review articles including a
similar manuscript in this journal.