Department of Urology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium,
Drugs Aging. 2013 Nov;30(11):877-86. doi: 10.1007/s40266-013-0117-5.
Bone metastases are very common in advanced renal cell carcinoma (RCC) and can have a huge impact on quality of life by leading to skeletal-related events (SREs), including pain, pathologic fractures and spinal cord compression with need for surgery or radiotherapy. Because of their osteolytic aspect and biologic behaviour, these SREs are more common in patients with bone metastases from RCC than from other malignancies. As overall survival is increased by new anti-angiogenic drugs like tyrosine kinase inhibitors and mammalian target of rapamycin inhibitors, the incidence of SREs is rising, making the clinical management of bone metastases in RCC ever more important, especially in the more vulnerable elderly patient. In this review we discuss the current advances and future directions in bone-targeted therapies in patients with RCC with a special focus on the elderly population. Recently, two bone-targeted agents have been approved in the prevention of SREs in advanced RCC: zoledronic acid and denosumab. To date, there is no specific data on the use of bisphosphonates or denosumab in the elderly and specific studies in this setting are warranted. We compare the available evidence for the use and implications of both agents in the elderly patient and give general information on safety concerns that could be more important in these patients.
骨转移在晚期肾细胞癌（RCC）中非常常见，可通过导致骨骼相关事件（SREs）对生活质量产生巨大影响，这些 SREs 包括疼痛、病理性骨折和脊髓压迫，需要手术或放射治疗。由于这些 SREs具有溶骨性特征和生物学行为，因此在 RCC 骨转移患者中比在其他恶性肿瘤患者中更为常见。随着新型抗血管生成药物（如酪氨酸激酶抑制剂和哺乳动物雷帕霉素靶蛋白抑制剂）的出现，总体生存率得到提高，SRE 的发生率也在上升，因此 RCC 骨转移的临床管理变得越来越重要，尤其是在更为脆弱的老年患者中。在这篇综述中，我们讨论了 RCC 患者骨靶向治疗的最新进展和未来方向，特别关注老年人群。最近，两种骨靶向药物已被批准用于预防晚期 RCC 的 SREs：唑来膦酸和地舒单抗。迄今为止，尚无关于在老年人群中使用双膦酸盐或地舒单抗的数据，因此需要在这一人群中开展特定的研究。我们比较了这两种药物在老年患者中的使用和影响的现有证据，并提供了关于安全性问题的一般信息，这些问题在这些患者中可能更为重要。
