Academic Unit of Clinical Oncology, Weston Park Hospital, CR-UK/YCR Sheffield Cancer Research Centre, Sheffield, UK.
Curr Opin Support Palliat Care. 2012 Sep;6(3):322-9. doi: 10.1097/SPC.0b013e32835689cd.
Bone-targeted treatments with bisphosphonates (e.g., zoledronic acid) and denosumab are known to reduce the risk of skeletal complications and prevent treatment-induced bone loss in patients with malignant bone disease. Additionally, these drugs may modify the course of bone destruction via inhibitory effects on the 'vicious cycle' of growth factor and cytokine signalling between tumour and bone cells within the bone marrow microenvironment.
In early stage breast cancer, treatment with zoledronic acid has shown improvements in disease-free and overall survival, notably in women with established menopause at diagnosis and in premenopausal women with endocrine-responsive disease, treated with goserelin to suppress ovarian function. Other bisphosphonates such as clodronate may produce similar benefits. Additionally, in castrate-resistant prostate cancer, treatment with denosumab delays the development of bone metastases.
These results strongly support the adjuvant use of bone-targeted treatments, but suggest that reproductive hormones are an important treatment modifier to take into account.
双膦酸盐（如唑来膦酸）和地舒单抗的骨靶向治疗已被证实可降低恶性骨病患者发生骨骼并发症的风险，并预防治疗引起的骨丢失。此外，这些药物可能通过抑制肿瘤细胞和骨髓微环境中的骨细胞之间生长因子和细胞因子信号的“恶性循环”，改变骨破坏的过程。
在早期乳腺癌中，唑来膦酸治疗可改善无病生存率和总生存率，尤其是在诊断时已绝经和接受戈舍瑞林抑制卵巢功能治疗的内分泌敏感疾病的绝经前妇女中。其他双膦酸盐如氯膦酸可能产生类似的益处。此外，在去势抵抗性前列腺癌中，地舒单抗治疗可延迟骨转移的发生。
这些结果强烈支持骨靶向治疗的辅助应用，但提示生殖激素是一个重要的治疗修饰因素，需要考虑在内。
