The use of Bisphosphonates in Patients with Breast Cancer

2002 ◽  
Vol 9 (6) ◽  
pp. 480-489 ◽  
Author(s):  
Catherine H. Van Poznak
Keyword(s):  
Breast Cancer ◽  
Spinal Cord ◽  
Randomized Clinical Trials ◽  
Bone Destruction ◽  
Metastatic Breast ◽  
Cord Compression ◽  
Bisphosphonate Therapy ◽  
Skeletal Metastases ◽  
Cancer Management ◽  
Pathologic Fractures

Background Bone is the most common site of breast cancer metastases. Skeletal metastases may be associated with harmful and painful events such as fractures, spinal cord compression, and hypercalcemia. By inhibiting osteoclasts and bone resorption, bisphosphonates can interrupt the process of bone destruction and decrease the risk of skeletal complications. Methods A review of the literature was undertaken regarding the use of bisphosphonates in breast cancer management, with particular attention to prospective, randomized clinical trials that have influenced the treatment of bone metastases. Results Large prospective, randomized trials have demonstrated that bisphosphonates are effective in reducing skeletal-related complications from metastatic breast cancer. Conclusions For many patients with osseous lesions from breast cancer, bisphosphonate therapy is a useful intervention in managing their disease. Bisphosphonates are the treatment of choice for hypercalcemia of malignancy and bisphosphonates reduce the risk of pathologic fractures, spinal cord compromise, the need for radiation or surgery to bone, and bone pain.

scholarly journals The Role of Bisphosphonates in Breast Cancer

2003 ◽  
Vol 1 (2) ◽  
pp. 232-241 ◽  
Author(s):  
Richard L. Theriault
Keyword(s):  
Breast Cancer ◽  
Zoledronic Acid ◽  
Bone Destruction ◽  
Standard Of Care ◽  
Cord Compression ◽  
Skeletal Metastases ◽  
Radiographic Appearance ◽  
Pathologic Fractures ◽  
Osteolytic Metastases ◽  
Microenvironmental Factors

Breast cancer frequently metastasizes to bone. Metastases result in skeletal morbidity including pathologic fractures, the need for radiation or surgery to bone, spinal cord compression and hypercalcemia. The pathophysiology of bone destruction is related to activation of osteoclasts by tumor-derived and bone marrow microenvironmental factors. One prominent osteoclast–activating factor associated with breast cancer is parathyroid hormone-related peptide (PTHrP). Bisphosphonates have been shown to impair osteoclast activity by decreasing recruitment from the monocyte macrophage cell line, inhibiting osteoclast function at the bone site and causing osteoclasts to undergo apoptosis. Clinical studies with bisphosphonates show an improvement in the control of hypercalcemia and a reduction in skeletal related morbidity with administration of pamidronate and zoledronic acid. Bisphosphonates have become the standard of care for osteolytic metastases associated with breast cancer. Recent data with zoledronic acid found that skeletal related morbidity may be reduced regardless of the radiographic picture of skeletal metastases. Thus, zoledronic acid may be valuable in osteolytic and osteoblastic disease as well as in disease with an osteolytic or osteoblastic radiographic appearance. In breast cancer with osteolytic disease, zoledronic acid may be more effective than pamidronate in reducing skeletal morbidity and prolonging the time to first skeletal event.

scholarly journals PTH1R-CaSR Cross Talk: New Treatment Options for Breast Cancer Osteolytic Bone Metastases

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Yanmei Yang ◽  
Bin Wang
Keyword(s):  
Breast Cancer ◽  
Bone Metastases ◽  
Treatment Options ◽  
Bone Destruction ◽  
Metastatic Breast ◽  
Tumor Burden ◽  
Skeletal Metastases ◽  
Vicious Cycle ◽  
Calcium Sensing ◽  
New Treatment

Metastatic breast cancer (BrCa) is currently incurable despite great improvements in treatment of primary BrCa. The incidence of skeletal metastases in advanced BrCa occurs up to 70%. Recent findings have established that the distribution of BrCa metastases to the skeleton is not a random process but due to the favorable microenvironment for tumor invasion and growth. The complex interplay among BrCa cells, stromal/osteoblastic cells, and osteoclasts in the osseous microenvironment creates a bone-tumor vicious cycle (a feed-forward loop) that results in excessive bone destruction and progressive tumor growth. Both the type 1 PTH receptor (PTH1R) and extracellular calcium-sensing receptor (CaSR) participate in the vicious cycle and influence the skeletal metastatic niche. Thus, this review focuses on how the PTH1R and CaSR signaling pathways interact and contribute to the pathogenesis of BrCa bone metastases. The effects of intermittent PTH and allosteric modulators of CaSR for the use of bone-anabolic agents and prevention of BrCa bone metastases constitute a proof of principle for therapeutic consideration. Understanding the interplay between PTH1R and CaSR signaling in the development of BrCa bone metastases could lead to a novel therapeutic approach to control both osteolysis and tumor burden in the bone.

scholarly journals Management Challenges of Metastatic Spinal Cord Compression in Pregnancy

2020 ◽  
Vol 2020 ◽  
pp. 1-11
Author(s):  
Davor Dasic ◽  
Narendra K. Rath ◽  
Mario Ganau ◽  
Zaid Sarsam
Keyword(s):  
Breast Cancer ◽  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Spinal Instrumentation ◽  
Metastatic Breast ◽  
Well Being ◽  
Cord Compression ◽  
Lower Limbs ◽  
Healthy Baby ◽  
Thoracic Spinal

Primary and secondary spinal tumours with cord compression often represent a challenging condition for the patient and clinicians alike, even more so during pregnancy. The balance between safe delivery of a healthy baby and management of the mother’s disease bears many clinical, psychological, and ethical dilemmas. Pregnancy sets a conflict between the optimal surgical and oncological managements of the mother’s tumour and the well-being of her foetus. We followed the CARE guidelines from the EQUATOR Network to report an exemplificative case of a 39-year-old woman with a 10-year history of breast cancer, presenting in the second trimester of her first pregnancy with acute onset severe thoracic spinal instability, causing mechanical pain and weakness in lower limbs. Neuroradiological investigations revealed multilevel spinal deposits with a pathological T10 fracture responsible for spinal cord compression. The patient was adamant that she wanted a continuation of the pregnancy and her baby delivered. After discussion with her oncologist and obstetrician, we agreed to perform emergency spinal surgery—decompression and instrumented fixation. The literature search did not reveal a similar case of spinal metastatic breast cancer undergoing spinal instrumentation and delivery of a healthy baby a few months later. Following the delivery, the patient had further oncological treatment, including chemotherapy and radiotherapy. The paucity of such reports prompted us to present this case and highlight the relevance of a multidisciplinary approach involving obstetrician, oncologist, spinal surgeon, and radiologist to guide the optimal decision-making process.

scholarly journals Breast Cancer with Bone Metastasis: Molecular Insights and Clinical Management

Cells ◽  
2021 ◽  
Vol 10 (6) ◽  
pp. 1377
Author(s):  
Konstantinos Venetis ◽  
Roberto Piciotti ◽  
Elham Sajjadi ◽  
Marco Invernizzi ◽  
Stefania Morganti ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Bone Metastasis ◽  
Clinical Management ◽  
Bone Destruction ◽  
Metastatic Breast ◽  
Breast Cancer Patients ◽  
Incurable Condition ◽  
Skeletal Related Events ◽  
Relevant Topic ◽  
Systemic Therapies

Despite the remarkable advances in the diagnosis and treatment of breast cancer patients, the presence or development of metastasis remains an incurable condition. Bone is one of the most frequent sites of distant dissemination and negatively impacts on patient’s survival and overall frailty. The interplay between tumor cells and the bone microenvironment induces bone destruction and tumor progression. To date, the clinical management of bone metastatic breast cancer encompasses anti-tumor systemic therapies along with bone-targeting agents, aimed at slowing bone resorption to reduce the risk of skeletal-related events. However, their effect on patients’ survival remains controversial. Unraveling the biology that governs the interplay between breast neoplastic cells and bone tissue would provide means for the development of new therapeutic agents. This article outlines the state-of-the art in the characterization and targeting the bone metastasis in breast cancer, focusing on the major clinical and translational studies on this clinically relevant topic.

scholarly journals Epidemiology of spinal cord and column tumors

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. i5-i9
Author(s):  
Joshua T Wewel ◽  
John E O’Toole
Keyword(s):  
Spinal Cord ◽  
Treatment Options ◽  
Survival Rates ◽  
Spinal Metastases ◽  
Cord Compression ◽  
Severe Form ◽  
Spinal Instability ◽  
Treatment Cascade ◽  
Tumor Pathology ◽  
Pathologic Fractures

Abstract The spine is a frequent location for metastatic disease. As local control of primary tumor pathology continues to improve, survival rates improve and, by extension, the opportunity for metastasis increases. Breast, lung, and prostate cancer are the leading contributors to spinal metastases. Spinal metastases can manifest as bone pain, pathologic fractures, spinal instability, nerve root compression, and, in its most severe form, spinal cord compression. The global extent of disease, the spinal burden, neurologic status, and life expectancy help to categorize patients as to their candidacy for treatment options. Efficient identification and workup of those with spinal metastases will expedite the treatment cascade and improve quality of life.

scholarly journals Spinal cord compression in breast cancer: a review of 70 cases

1993 ◽  
Vol 68 (5) ◽  
pp. 969-973 ◽  
Author(s):  
ME Hill ◽  
MA Richards ◽  
WM Gregory ◽  
P Smith ◽  
RD Rubens
Keyword(s):  
Breast Cancer ◽  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Cord Compression

scholarly journals Management of Breast Cancer in Nepal

2009 ◽  
Vol 48 (175) ◽  
Author(s):  
Yogendra P Singh ◽  
P Sayami
Keyword(s):  
Breast Cancer ◽  
Early Detection ◽  
Cancer Education ◽  
Tumor Biology ◽  
Metastatic Breast ◽  
Premenopausal Women ◽  
Clinical Breast Examination ◽  
Cancer Management ◽  
Breast Cancer Management ◽  
Clinical Breast

Breast cancer is the second most common malignancy among women in Nepal. It is more commonin young premenopausal women. Breast cancer continues to increase in incidence due to lifestylechanges in Nepalese women despite constant remarkable development in the management of thisdisease over the past three decades. Breast cancer was diagnosed solely clinically and surgery wasthe only treatment option until fi fty years ago. Multidisciplinary approach has been adopted fordiagnosis and treatment of breast cancer in Nepal. Imaging is required for the diagnosis, appropriatetreatment decision and proper follow up. Treatment modality depends upon the extent of thedisease and tumor biology. However, there is a strong need for standard guidelines for the propermanagement of breast cancer in Nepal so that surgeries, chemotherapy, hormone therapy andradiotherapy are standardized in the country. Palliative care has been initiated to provide to somepatients with metastatic breast cancer recently.The breast cancer management in Nepal is a little different when compared with the centers in thedeveloped countries. The reasons are socioeconomic status, lack of education and lack of facilities.Although cancer care is on the rise in Nepal, the optimal facility for centers managing breast cancerhas to be improved signifi cantly.Cancer education, screening and early detection are the keyelements to infl uence the diagnosis, treatment and prognosis of breast cancer in Nepal. Breast cancerawareness and clinical breast examination are important tools for early detection in our resourcelimited context. Breast cancer can be cured in majority of the cases if diagnosed in early stages.This review will focus on relevant patient data along with future recommendation regarding breastcancer treatment in Nepal.Key Words: Breast cancer, cancer education, chemotherapy, imaging, radiotherapy, surgery

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