Department of Medical Oncology, Royal North Shore Hospital, Sydney, NSW, Australia.
Breast Cancer (Dove Med Press). 2011 May 2;3:35-60. doi: 10.2147/BCTT.S6655.
Bone metastasis in breast cancer is a significant clinical problem. It not only indicates incurable disease with a guarded prognosis, but is also associated with skeletal-related morbidities including bone pain, pathological fractures, spinal cord compression, and hypercalcemia. In recent years, the mechanism of bone metastasis has been further elucidated. Bone metastasis involves a vicious cycle of close interaction between the tumor and the bone microenvironment. In patients with bone metastases, the goal of management is to prevent further skeletal-related events, manage complications, reduce bone pain, and improve quality of life. Bisphosphonates are a proven therapy for the above indications. Recently, a drug of a different class, the RANK ligand antibody, denosumab, has been shown to reduce skeletal-related events more than the bisphosphonate, zoledronic acid. Other strategies of clinical value may include surgery, radiotherapy, radiopharmaceuticals, and, of course, effective systemic therapy. In early breast cancer, bisphosphonates may have an antitumor effect and prevent both bone and non-bone metastases. Whilst two important Phase III trials with conflicting results have led to controversy in this topic, final results from these and other key Phase III trials must still be awaited before a firm conclusion can be drawn about the use of bisphosphonates in this setting. Advances in bone markers, predictive biomarkers, multi-imaging modalities, and the introduction of novel agents have ushered in a new era of proactive management for bone metastases in breast cancer.
乳腺癌的骨转移是一个重大的临床问题。它不仅表明疾病无法治愈，预后不佳，而且还与骨骼相关的并发症有关，包括骨痛、病理性骨折、脊髓压迫和高钙血症。近年来，骨转移的机制得到了进一步阐明。骨转移涉及肿瘤与骨微环境之间密切相互作用的恶性循环。在有骨转移的患者中，管理的目标是预防进一步的骨骼相关事件、处理并发症、减轻骨痛和提高生活质量。双膦酸盐是上述适应证的有效治疗药物。最近，一种不同类别的药物，即 RANK 配体抗体地舒单抗，已被证明比双膦酸盐唑来膦酸更能减少骨骼相关事件。其他具有临床价值的策略可能包括手术、放疗、放射性药物，当然还有有效的全身治疗。在早期乳腺癌中，双膦酸盐可能具有抗肿瘤作用，并能预防骨转移和非骨转移。虽然两项重要的 III 期临床试验结果相互矛盾，导致了这一话题的争议，但最终结果仍有待于这些试验和其他关键 III 期试验的结果公布，才能得出关于在这种情况下使用双膦酸盐的明确结论。骨标志物、预测生物标志物、多成像方式和新型药物的进展为乳腺癌骨转移的积极管理带来了一个新时代。
