Leigh Jennifer, Lee Shing Fung, Fawaz Ali, Jia Jason, Theriau Christopher F, Rodrigues Jessica, Brown Janet, Ng Terry L
Division of Medical Oncology, Department of Medicine, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada.
Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore.
Curr Opin Support Palliat Care. 2025 Jun 1;19(2):117-129. doi: 10.1097/SPC.0000000000000749. Epub 2025 Feb 14.
Skeletal metastases occur in approximately 80% of advanced breast, 70% of advanced prostate, and 30% of lung cancers, and place patients at increased risk of skeletal related events (SRE). Bone modifying agents (BMAs) have been shown to prevent or delay SRE development. Our objective was to summarize the role of these agents in the management of these three cancers.
Total 52 studies met our inclusion criteria. These highlighted the benefit of BMAs in reducing SREs in metastatic breast and castrate resistant prostate cancer (mCRPC), with less clear impact on reducing SRE in lung cancer, or on improving progression-free and overall survival due to significant heterogeneity in trial design and outcomes. Benefits in SRE reduction occurred with bisphosphonates and denosumab, however when compared, denosumab was superior. Denosumab however is not more cost effective, and multiple trials support potential de-escalation to either 12 weekly dosing or other reduced duration.
There is a large body of evidence to support the role of BMAs in reducing SREs in metastatic breast and mCRPC. Impact on survival outcomes is heterogeneous, and future large database trials would be helpful in identifying which subgroups of patients truly have survival benefit from BMAs.
骨转移发生在约80%的晚期乳腺癌、70%的晚期前列腺癌和30%的肺癌患者中，会增加患者发生骨相关事件（SRE）的风险。骨改良剂（BMA）已被证明可预防或延缓SRE的发生。我们的目的是总结这些药物在这三种癌症治疗中的作用。
共有52项研究符合我们的纳入标准。这些研究突出了BMA在降低转移性乳腺癌和去势抵抗性前列腺癌（mCRPC）的SRE方面的益处，而对降低肺癌SRE或改善无进展生存期和总生存期的影响不太明确，因为试验设计和结果存在显著异质性。双膦酸盐和地诺单抗均可降低SRE，但相比之下，地诺单抗更具优势。然而，地诺单抗的性价比并不更高，多项试验支持可将给药方案降级为每12周一次或缩短给药时长。
有大量证据支持BMA在降低转移性乳腺癌和mCRPC的SRE方面的作用。对生存结局的影响存在异质性，未来的大型数据库试验将有助于确定哪些亚组患者确实能从BMA中获得生存益处。
