Bone-Targeted Therapy in Advanced Breast Cancer
The bone is one of the three most common metastatic sites of breast cancer. Bone metastatic disease has a favorable prognosis compared to visceral metastatic disease, but skeletal event (pain, pathologic fractures, hypercalcemia and spinal cord compression)-related morbidity and decreased quality of life have a large overall impact. Osteoclasts and the loss of equilibrium between osteoclasts and osteoblasts play major roles in bone metastasis. Bisphosphonates inhibit bone resorption by inducing apoptosis of osteoclasts. Denosumab is as a monoclonal antibody against receptor activator of nuclear factor (NF)-KB ligand, which is essential for osteoclast survival. To reduce the burden of bone metastasis, prevention is crucial in advanced cancer patients without skeletal involvement. However, given the available data regarding bisphosphonates in advanced breast cancer (ABC) without osseous involvement, international guidelines do not support the preventive use of bone-targeted agents. The toxicities of bisphosphonates and denosumab include hypocalcemia, renal toxicity, gastrointestinal disturbance and osteonecrosis of the jaw, which should be carefully reviewed when administering drugs and making decisions about dose, interval and duration.
KeywordsBone metastasis Targeted therapy Bisphosphonates Denosumab Osteonecrosis
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