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Reducing the burden of bone metastases

Current concepts and treatment options

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Abstract

Background

Bone metastases occur frequently in patients with solid tumours such as those of the prostate, breast and lung, and are associated with an increased risk of skeletal-related events (SREs). This article reviews the personal, social and economic burdens of bone metastases and SREs, and approaches to treatment.

Methods

PubMed searches were conducted using a broad range of search terms. Articles identified were refined by author review of abstracts. Additional material was identified by searching recent relevant congress abstracts.

Results

Bone metastases often decrease quality of life, but quantitative data on the extent of this effect are limited. Data from the USA demonstrate a significant financial burden associated with bone metastases; similar trends are now being uncovered in Europe as the number of assessments of health economics and healthcare resource utilisation in the region increases. The bisphosphonate zoledronic acid reduces the incidence of SREs compared with placebo. Recent phase 3 studies have shown that therapy with the RANK ligand inhibitor denosumab is superior to zoledronic acid for preventing or delaying SREs in patients with bone metastases from solid tumours. Denosumab also has a comparable safety profile to bisphosphonates, with reduced risk of renal toxicity and acute phase reactions. Data from Europe suggest that denosumab is cost-effective for the prevention of SREs compared with zoledronic acid. Additionally, several new experimental bone-targeted agents show promise.

Conclusion

Recent progress may help to reshape evidence-based guidelines to improve patient care and reduce the economic burden of bone metastases.

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Acknowledgments

The authors would like to thank Dr. Steven Inglis (PhD) of Oxford PharmaGenesis™ Ltd. for medical writing and editorial assistance with the manuscript. Funding for medical writing support was provided by Amgen (Europe) GmbH.

Conflicts of interest

Roger von Moos is a consultant to Roche, Novartis and Amgen, and has received honoraria from Roche and Amgen for presentations. Cora Sternberg has received honoraria for presentations related to the use of bisphosphonates/denosumab. Jean-Jacques Body has received consultancy and lecture fees from Amgen and Novartis. Carsten Bokemeyer has received honoraria for presentations related to the use of bisphosphonates/denosumab.

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Authors and Affiliations

  1. Medical Oncology/Haematology, Kantonsspital Graubünden, 7000, Chur, Switzerland

    Roger von Moos

  2. Department of Medical Oncology, San Camillo Forlanini Hospitals, Rome, Italy

    Cora Sternberg

  3. Department of Medicine, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, Belgium

    Jean-Jacques Body

  4. Department of Oncology, Hematology, BMT with Section Pneumology, University Medical Center Hamburg–Eppendorf, Hamburg, Germany

    Carsten Bokemeyer

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  1. Roger von Moos
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Correspondence to Roger von Moos.

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von Moos, R., Sternberg, C., Body, JJ. et al. Reducing the burden of bone metastases. Support Care Cancer 21, 1773–1783 (2013). https://doi.org/10.1007/s00520-013-1755-1

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