Preventing metastases to bone: denosumab or bisphosphonates?

摘要

Bone is a preferred site for metastases owing to local signals that promote skeletal colonization.'1'2' As metastases occur, the normally tempered osteoclasts are transformed into unruly bullies, proliferating and resorbing bone with abandon. For cancer patients, the unrelenting progression of bone metastases results in hypercalcemia, immobilizing fractures, loss of independence, and costly hospitalizations. Fortunately for patients, a continuing scientific effort has advanced our understanding of osteoclast biology with the identification of pathways that promote the differentiation, survival, and function of these cells.'31 This progress from basic science to clinical application revealed targets for treatment and the promise of reduced suffering from skeletal-related events (SREs). More than two decades ago, bisphosphonate therapy provided an advance to older, less efficient, and untargeted therapies for SREs by reducing osteoclast survival.'4' Bisphosphonates quickly became the therapy of choice, but they are not uniformly effective because some cancer patients continue to develop SREs despite therapy.