Biskup Ewelina, Cai Fengfeng, Vetter Marcus
University Hospital, Department of Internal Medicine, Basel, Switzerland.
University Hospital Yangpu, Department of Breast Cancer Surgery, Shanghai, China.
Swiss Med Wkly. 2017 Jun 23;147:w14440. doi: 10.4414/smw.2017.14440. eCollection 2017 Jul 11.
Bone targeted therapies are of increasing importance, not only for bone health in the clinical course of breast cancer, but recently also in the adjuvant setting as preventative, anticancer and prognosis-improving agents. It is well established that women with advanced breast cancer receive bisphosphonates or denosumab to prevent therapy-related osteoporosis. As many as 70% of these patients suffer from bone metastases and receive bone targeted agents in order to prevent skeletal related events (SREs), which are debilitating or diminish the quality of life. A number of trials provided guidance, identifying zoledronic acid as the most efficient bisphosphonate, showing that intravenous bisphosphonate administration is superior to oral intake and illustrating the different safety profile of denosumab, which has been reported to be more beneficial than zoledronic acid in delaying the time to first and subsequent (multiple) SREs. New studies have suggested that bone targeted therapies improve rates of overall survival and contribute to preventing recurrence of breast cancer at all sites. Increased bone turnover is both a consequence and a driving factor for tumour growth, expansion, formation of bone lesions and potentially also activation of disseminated tumour cells, leading to bone relapses. We review the current knowledge of bone targeted therapies in advanced breast cancer, with a focus on new insights into their bone-preserving and antitumor activity. Current guidelines, pathology of bone metastasis, mode of action and common side effects have been summarised. We also elaborate on the use of bisphosphonates and denosumab in early breast cancer, during adjuvant therapy with aromatase inhibitors.
骨靶向治疗正变得越来越重要，不仅对于乳腺癌临床病程中的骨骼健康，而且最近在辅助治疗中作为预防、抗癌和改善预后的药物也日益重要。众所周知，晚期乳腺癌女性接受双膦酸盐或地诺单抗以预防治疗相关的骨质疏松症。多达70%的此类患者患有骨转移，并接受骨靶向药物以预防骨骼相关事件（SREs），这些事件会使人衰弱或降低生活质量。多项试验提供了指导，确定唑来膦酸是最有效的双膦酸盐，表明静脉注射双膦酸盐优于口服，并说明了地诺单抗不同的安全性，据报道，在延迟首次和随后（多次）SREs的发生时间方面，地诺单抗比唑来膦酸更有益。新的研究表明，骨靶向治疗可提高总生存率，并有助于预防乳腺癌在所有部位的复发。骨转换增加既是肿瘤生长、扩展、骨病变形成以及潜在的播散肿瘤细胞激活导致骨复发的结果，也是其驱动因素。我们综述了晚期乳腺癌骨靶向治疗的当前知识，重点关注其保骨和抗肿瘤活性的新见解。总结了当前的指南、骨转移的病理学、作用方式和常见副作用。我们还阐述了双膦酸盐和地诺单抗在早期乳腺癌芳香化酶抑制剂辅助治疗期间的应用。
