Department of Medical Oncology, Kinki University School of Medicine, Osaka-Sayama, Osaka, Japan.
Jpn J Clin Oncol. 2012 Aug;42(8):663-9. doi: 10.1093/jjco/hys088. Epub 2012 Jun 13.
Bone metastases are known to be caused by all types of cancer. Cancer metastasis to bone has been said to considerably compromise patients' quality of life and adversely affect lifetime prognosis. Although progress in cancer treatment has prolonged survival significantly, this may make increased numbers of patients suffer from bone metastases. Until now, as for the treatment of bone metastases, local therapies, including radiation therapy and surgery, were performed mainly as palliative therapies. However, bisphosphonate-based therapies have recently become available and are frequently administered to delay or prevent skeletal-related events, which include pathologic bone fracture, spinal cord compression, radiologic treatment for bone lesions, surgical procedures for bone lesions and hypercalcemia. Moreover, denosumab, the first fully human monoclonal antibody to receptor activator of nuclear factor κ-B ligand, was approved in the USA because of its evidence-supported clinical effects. Denosumab was effective for prolonging the time to skeletal-related events and inhibiting the onset of pain via the suppression of osteoclast activation. Denosumab has been shown to have a greater effect compared with zoledronic acid, most notably in patients with breast or prostate cancer. In this article, the efficacy and safety of denosumab for the treatment of bone metastases in patients with various advanced cancers are discussed.
已知骨转移是由所有类型的癌症引起的。癌症转移到骨骼已被认为极大地降低了患者的生活质量，并对其终生预后产生不利影响。尽管癌症治疗的进展显著延长了患者的生存期，但这可能会使越来越多的患者遭受骨转移的困扰。到目前为止，对于骨转移的治疗，包括放射治疗和手术在内的局部治疗主要作为姑息性治疗。然而，基于双膦酸盐的治疗方法最近已经出现，并经常被用于延迟或预防骨骼相关事件，这些事件包括病理性骨折、脊髓压迫、骨病变的放射治疗、骨病变的手术和高钙血症。此外，由于其有证据支持的临床效果，美国已批准 denosumab（一种针对核因子-κB 配体受体激活剂的全人源单克隆抗体）用于治疗。denosumab 通过抑制破骨细胞的激活，延长骨骼相关事件的发生时间并抑制疼痛的发生，从而具有疗效。与唑来膦酸相比，denosumab 的效果更大，尤其是在乳腺癌或前列腺癌患者中。本文讨论了 denosumab 治疗各种晚期癌症患者骨转移的疗效和安全性。
