Basics of Oncology by Frederick O. Stephens & Karl Reinhard Aigner

Author:Frederick O. Stephens & Karl Reinhard Aigner
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

12.3 Breast Cancer and Bone-Modifying Drugs

Bone is the primary site for breast cancer metastasis, representing a significant burden of disease and leading to fractures, spinal cord compression, pain and hypercalcaemia. Breast cancer patients often live many years with skeletal metastasis, with an average survival of 4 years [261, 262]. The tendency of breast cancer to metastasise to bone represents a complex interaction between metastatic cancer cells, bone and the intermediary local microenvironment. Bone-targeted therapy with bisphosphonates has significantly improved the systemic management of patients with advanced breast cancer by decreasing the frequency and morbidity of skeletal-related events (SREs).

Bisphosphonates

Bisphosphonates are structural analogues of pyrophosphate that embed into bone, binding to hydroxyapatite and inhibiting osteoclast activity and survival. Thus, bisphosphonates can inhibit tumour-mediated osteolysis driven by osteoclast activation. There are two classes of bisphosphonates, nitrogen containing and non-nitrogen containing [261], which differ in potency and direct mechanisms of action. Bisphosphonates have also been shown to have effects independent of their antiresorptive properties, including evidence of immunomodulatory properties. Bisphosphonates may also have been associated to antiproliferative and antiangiogenic effects [263].

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