Ottewell Penny, Wilson Caroline
Department of Oncology & Metabolism, The Medical School, The University of Sheffield, Sheffield, UK.
Weston Park Cancer Hospital, Sheffield Teaching Hospitals NHS Trust, UK.
Breast Cancer (Auckl). 2019 Sep 18;13:1178223419843501. doi: 10.1177/1178223419843501. eCollection 2019.
The bone-targeted agents (BTAs), bisphosphonates and denosumab, have an established role in the treatment of metastatic breast cancer bone disease and the prevention of cancer-treatment-induced bone loss. Evidence in support of their ability to improve survival in early breast cancer now indicates that the bisphosphonates are effective in postmenopausal women (naturally or chemically induced), but denosumab does not have similar benefits when added to standard adjuvant therapy. In postmenopausal women with early breast cancer, the choice of BTA may differ depending on the indication for treatment; for fracture prevention in low disease recurrence risk patients, denosumab may be favoured (in comparison with placebo) to maintain bone health, and when disease recurrence prevention is a priority in higher risk patients, bisphosphonates may be favoured. The reason for the lack of efficacy of BTAs in premenopausal/perimenopausal patients still remains unanswered and will need preclinical research to evaluate novel treatment combinations with BTAs in this patient group. This review covers the past, present, and future indications for BTAs in both metastatic and early breast cancer.
骨靶向药物（BTAs），即双膦酸盐类药物和地诺单抗，在转移性乳腺癌骨病的治疗以及预防癌症治疗引起的骨质流失方面已确立了作用。支持它们能够提高早期乳腺癌患者生存率的证据现在表明，双膦酸盐类药物对绝经后女性（自然绝经或化学诱导绝经）有效，但在标准辅助治疗中添加地诺单抗并无类似益处。在患有早期乳腺癌的绝经后女性中，BTA的选择可能因治疗指征而异；对于疾病复发风险较低的患者预防骨折，地诺单抗（与安慰剂相比）可能更有利于维持骨骼健康，而对于高风险患者，当预防疾病复发是首要任务时，双膦酸盐类药物可能更受青睐。BTAs在绝经前/围绝经期患者中缺乏疗效的原因仍未得到解答，需要进行临床前研究以评估该患者群体中BTAs与新型治疗组合的效果。本综述涵盖了BTAs在转移性和早期乳腺癌中的过去、现在和未来的应用指征。
