Bisphosphonates in breast cancer: teaching an old dog new tricks.
OBJECTIVE
Bisphosphonates are potent inhibitors of bone resorption that reduce the risk of skeletal complications and prevent treatment-induced bone loss. However, recent data suggest that bisphosphonate use in breast cancer may provide more than just supportive care and modify the course of the disease by disrupting the metastatic process.


RESULTS
Research in the metastatic setting is focused on refining treatment, using bone markers to identify high-risk patients and define optimal schedules, potentially leading to personalized therapy. In the prevention of cancer treatment-induced bone loss (CTIBL), a large number of studies have demonstrated the efficacy of oral and intravenous bisphosphonates and recent guidelines have defined management strategies for CTIBL. Preclinical studies have reported direct antitumour effects of bisphosphonates, particularly in combination with chemotherapy. In the clinical setting the antitumour effect is less clear, but recent data suggest that zoledronic acid may modify the course of the disease and reduce disease recurrence.


CONCLUSIONS
Bisphosphonates are comprehensively established in the treatment of metastatic bone disease and significantly reduce skeletal morbidity. Their role in the prevention of cancer treatment-induced bone disease is also defined. The potential antitumour and disease-modifying role of adjuvant bisphosphonates holds promise but results from ongoing studies must be awaited before this becomes standard practice.
Winter
Matthew C
MC
Academic Unit of Clinical Oncology, Weston Park Hospital, University of Sheffield, Sheffield, UK. m.c.winter@sheffield.ac.ukBack to Top
Coleman
Robert E
RE
D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D001862:Bone Resorption / Q000139:chemically induced / Q000517:prevention & control; D001943:Breast Neoplasms / Q000188:drug therapy*; D004164:Diphosphonates / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007093:Imidazoles / Q000627:therapeutic use; D010024:Osteoporosis / Q000139:chemically induced / Q000517:prevention & control; D016896:Treatment Outcome; D000077211:Zoledronic Acid
D000970:Antineoplastic Agents; D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D000077211:Zoledronic Acid