scholarly journals Dealing with Bone Metastases from Breast Cancer - A Pathological and Clinical Overview

2018 ◽  
Vol 1 (Supplement) ◽  
pp. 25
Author(s):  
O. Munteanu ◽  
A. Dumitru ◽  
O. Bodean ◽  
L. Arsene ◽  
D. Voicu ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Bone Metastases ◽  
Malignant Tumors ◽  
Cord Compression ◽  
Pathological Fractures ◽  
Future Directions ◽  
Skeletal Related Events ◽  
Frequent Site ◽  
Clinical Overview

Abstract From breast malignant tumors, bone is the most frequent site of metastasis. Bone metastases from breast cancer are correlated with pathological fractures, spinal cord compression and other skeletal-related events as well as bone pain and hypercalcemia. These lead to impaired mobility, decreased quality of life, and overall decrease in survival. Clarification of mechanisms regulating bone metastasis has advanced greatly in the last years and this has translated into plentiful unused therapeutic options. Greater understanding of the pathophysiology of bone metastases has led to the detection and clinical efficiency of bone-targeted agents. This review summarizes the key evidence for current clinical practice and future directions.

Clinical Usefulness of Bisphosphonates in Oncology: Treatment of Bone Metastases, antitumoral Activity and Effect on Bone Resorption Markers

2007 ◽  
Vol 22 (1) ◽  
pp. 24-33 ◽  
Author(s):  
A. Verì ◽  
M.R. D'Andrea ◽  
P. Bonginelli ◽  
G. Gasparini
Keyword(s):  
Bone Metastases ◽  
Advanced Disease ◽  
Cord Compression ◽  
Antitumoral Activity ◽  
Pathological Fractures ◽  
Antiangiogenic Activity ◽  
Treatment And Prevention ◽  
Oncology Treatment ◽  
Skeletal Related Events

The present article overviews the role of bisphosphonates for the treatment and prevention of bone metastases and their antiangiogenic effects and antitumoral activity. The skeleton is a frequent and clinically relevant site of metastasis in cancer patients. The major events related to bone metastases include bone pain, bone loss, hypercalcemia, spinal cord compression, and fractures. On the basis of their radiographic features, bone metastases are classified as osteoblastic, osteoclastic, or mixed. The primary goals of treatment of bone metastases are reduction of the risk of pathological fractures and other skeletal-related events, and pain control. Bisphosphonates are used to prevent pathological fractures by inhibition of osteoclasts. Recent studies suggest that bisphosphonates have some direct antitumoral activity, mainly mediated through the blockade of angiogenic pathways. Further clinical studies are needed to determine the optimal treatment duration, timing and schedule of bisphosphonates, assess their role as adjuvant therapy for the prevention of bone metastases, and establish their antiangiogenic activity in association with standard cytotoxic and hormonal drugs for treatment of patients with advanced disease.

Burden of hospitalizations associated with skeletal related events in patients with breast cancer or lung cancer and bone metastases or multiple myeloma

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 17083-17083 ◽  
Author(s):  
M. Lage ◽  
D. J. Harrison ◽  
B. Barber ◽  
S. Jun
Keyword(s):  
Breast Cancer ◽  
Lung Cancer ◽  
Multiple Myeloma ◽  
Bone Metastases ◽  
Index Date ◽  
Opioid Analgesic ◽  
Cord Compression ◽  
Continuous Coverage ◽  
Diagnosis Of Cancer ◽  
Skeletal Related Events

17083 Background: Patients with bone metastases secondary to cancer often experience skeletal related events (SREs) including pathological fracture, spinal cord compression, hypercalcemia, bone surgery or radiotherapy, or initiation of opioid analgesic use. These SREs result in major morbidity and reduced quality of life. This research examines hospitalizations associated with SREs. Methods: Data for this study were obtained from i3 LabRx Database (05/01/2000 to 03/31/2005). Individuals were included in the analyses if they had at least two diagnoses of breast cancer (based upon an ICD-9 code of 174.xx), lung cancer (162.xx), or multiple myeloma (203.0x) and had at least two diagnoses of bone metastases (198.5x) after the first diagnosis of cancer. In addition, individuals were required to have at least one SRE (based upon a previously published algorithm) on or after their initial diagnosis of bone metastases (their index date). Individuals were required to be continuously insured for at least 6 months prior to, and at least one month post their index date. Data were analyzed until 03/31/2005 or until the end of their continuous coverage, whichever occurred first. Descriptive statistics for each of these cohorts are provided. Results: A total of 1,204 individuals with breast cancer, 1,094 with lung cancer, and 258 with multiple myeloma were included in the study. The vast majority of individuals with breast cancer (96.5%), lung cancer (95.9%), or multiple myeloma (96.8%) were hospitalized. All three patient groups were likely to have SRE-related hospitalizations; multiple myeloma 43.4%, breast cancer 36.2% and lung cancer 35.6%. The average number of days per patient year that patients were hospitalized related to a diagnosis or procedure for a SRE was 6.75 days for patients with lung cancer, 6.56 days for patients with multiple myeloma, and 3.75 days for patients with breast cancer. Conclusion: Hospitalizations related to SREs are common and the number of days per year is substantial. No significant financial relationships to disclose.

A randomized, double-blind trial evaluating the palliative benefit of either continuing pamidronate or switching to zoledronate in patients with high-risk bone metastases from breast cancer (The Odyssey Study).

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 155-155 ◽  
Author(s):  
Carmel Maree Jacobs ◽  
Iryna Kuchuk ◽  
Stephanie Smith ◽  
Sasha Mazzarello ◽  
Lisa Vandermeer ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
High Risk ◽  
Bone Metastases ◽  
Bone Turnover Marker ◽  
Symptom Improvement ◽  
Double Blind ◽  
Skeletal Related Events ◽  
Reduced Rate

155 Background: Questions remain around the optimal use of bone-targeted agents (BTA) in patients with bone metastases (BM) from breast cancer (BC). In Canada pamidronate (PAM) is the most commonly used BTA in BC.We explored whether a switch to a more potent BTA, like zoledronic acid (ZA), in patients who remain at high risk of skeletal related events (SREs) despite PAM use is associated with significant palliative benefit. Methods: BC patients with high risk BM (prior SRE, bone progression, bone pain or levels of bone turnover marker serum C-telopeptide (sCTX) >400ng/L) despite >3 months of PAM use were eligible. Patients were randomized in a double–blind manner to either switch to ZA or continue on PAM every 4 weeks for 12 weeks. Primary outcome was the proportion of patients achieving a fall in sCTX at 12 weeks. Secondary outcomes were pain control (BPI and FACT-BP) and toxicity. Results 73 patients completed the study. Median age 61 years (range 37 – 87), prior duration of PAM use 10 months (range 3 – 118). sCTX levels for all patients at baseline, 372+/- 471, week 12, 209 +/-290. Proportion of patients achieving a fall in sCTX from week 0 to week 12, 26/31 (84%) in ZA arm, 17/30 (57%) in PA arm, p=0.0262. Two patients were unable to complete the study due to deterioration in renal function (both receiving PAM), four due to progressive disease (two receiving ZA, two PAM), two patients chose to discontinue the study before completion (both receiving ZA). Four patients (5%) had SRE’s during the study, two receiving ZA, two receiving PAM. Quality of life and pain analysis shows no difference between week 0 and week 12 scores in either arm. Toxicity was predominantly grade 1 and 2, numerically there were more adverse effects in the ZA arm than PAM. Conclusion Switching patients with high risk BM from PAM to ZA leads to a reduction in sCTX levels but may be associated with more toxicity. Quality of life and pain scores were similar between the two treatments. While the literature suggests that a reduction in sCTX may correlate with reduced rate of SREs, given the lack of symptom improvement a switching strategy cannot be recommended. NCT01907880 Clinical trial information: NCT01907880.

scholarly journals NEW INFORMATION TECHNOLOGIES FOR ANALYSIS SKELETON PLANAR SCINTIGRAMMS OF PATIENTS WITH BREAST CANCER

2019 ◽  
Vol 23 (2) ◽  
pp. 187-196
Author(s):  
Xinmei Kang ◽  
N. E. Kosykh ◽  
E. A. Levkova ◽  
V. A. Razuvaev ◽  
S. Z. Savin
Keyword(s):  
Breast Cancer ◽  
Expert System ◽  
Bone Metastases ◽  
Information Technologies ◽  
Metastatic Lesion ◽  
High Tech ◽  
Mathematical Methods ◽  
System Building ◽  
Average Brightness

In work is described practical approach to the expert system building for the analysis skeleton planar scintigramms. The aim is to analyze the numerical characteristics of bone metastases by scintigraphy. Objective. Progress in the development of bioinformatics and mathematical methods in biomedicine, as well as the development of computer and telecommunications systems and networks determines the look of the present and future of oncology technology and of medicine in general. At last years of one of the directions of high-tech-medicine development is a processing the digital image: improvement of quality of image, recovering image, its recognition of separate elements. Recognition of pathological processes is one of the most important problems of processing the medical image. Methods and results. Method of computer-aided analysis of planar osteostsintigrammy studied the skeleton of patients with breast cancer are in complete remission and in the phase progression of the disease with metastases to the skeleton. As analyzed parameter was used brightness of images. The study of the physiological accumulation of radiopharmaceuticals in patients without metastasis to the skeleton indicates a wide variation in the brightness values of the scintigram in some areas of the skeleton. At the same anatomical areas of the skeleton there are significant differences in the values of the index of average brightness. In almost all areas of the skeleton averages of the brightness lesions hyperfixation RFP for scintigram significantly prevail over those of «physiological» lesions hyperfixation. Thus, there is a direct relationship between the levels of accumulation of the radiopharmaceutical in areas of the skeleton without metastatic lesion and bone metastases occurring in these zones. Consider methodological approaches to studies of quality of qualifier at the expert system building for the analysis skeleton planar scintigramms, as well as results of conducting calculations.

Bone modifying agents for patients with bone metastases from breast cancer managed in routine practice setting: Treatment patterns and outcome

2019 ◽  
Vol 26 (4) ◽  
pp. 906-911
Author(s):  
Jamal Zekri ◽  
Kamel Farag ◽  
Osama Yousof ◽  
Yazeed Zabani ◽  
Wael Mohamed ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Zoledronic Acid ◽  
Bone Metastases ◽  
Treatment Patterns ◽  
Routine Practice ◽  
Related Event ◽  
Modifying Agent ◽  
Skeletal Related Events ◽  
Skeletal Related Event

Introduction Bone metastases are common in patients with breast cancer and can lead to pain and skeletal-related events. Bone modifying agents are licensed to be used for these patients. We report the treatment patterns and outcome of zoledronic acid and denosumab in routine practice. Methodology Women with bone metastases from breast cancer who have started denosumab or zoledronic acid between 2011 and 2016 were eligible. Those with history of bone modifying agent use prior to diagnosis of bone metastases or with switching treatment between zoledronic acid and denosumab were excluded. Details of patients, tumors, bone modifying agent treatment, selected bone modifying agent toxicity, time to skeletal-related event development, and overall survival were collected retrospectively. Results In total, 163 women were eligible and included in this analysis. Number of skeletal-related events prior to starting bone modifying agents was 0, 1, 2, and 3 in 91 (55.8%), 53 (32.5%), 13 (8%), and 6 (3.7%), respectively. Zoledronic acid was started for 107 (65.6%) and denosumab for 56 (34.4%) patients. The proportion of patients receiving denosumab increased from 23.1 to 54.3% in years 2011 and 2016, respectively. Dose delay, reduction, and discontinuation due to toxicity were reported more frequently in patients receiving zoledronic acid. Denosumab delayed time to first on-treatment skeletal-related event compared with zoledronic acid (hazard ratio, 0.64; 95% CI, 0.41–0.98; log rank P = 0.044). There was no significant difference in median survival (zoledronic acid: 62 and denosumab: 58 months; log rank P = 0.956). Conclusion Denosumab is superior to zoledronic acid in reducing risk of skeletal-related events and in tolerance profile. However, overall survival is similar with both treatments. Our findings mirror those reported in scrutinized environment of landmark clinical trials.

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