[Bone metastases : New aspects of pathogenesis and systemic therapy].
The occurrence of bone metastases, in particular secondary to breast and prostate cancer, represents a complex medical condition that is debilitating for affected patients. In order to provide an efficient and personalized therapy, an interdisciplinary treatment approach is mandatory; therefore, systemic pharmacological therapy represents a core element of the overall treatment concept. In terms of pathophysiology, the cancer cells cause a massive disturbance of the local bone microenvironment, which as a rule leads to activation of bone resorbing osteoclasts. In addition to bisphosphonates, which can be considered classical antiresorptive agents, the monoclonal receptor activator of nuclear factor-kappa B ligand (RANKL) antibody denosumab has been in use in clinical practice since 2011. The alpha-emitting radioisotope Alpharadin was also recently approved for the treatment of metastatic prostate cancer. This article provides a summary of the most recent knowledge on the pathogenesis of how cancer cells alter the bone microenvironment as well as a review of established and future systemic treatment options.
Bereich Endokrinologie/Diabetes/Metabolische Knochenerkrankungen, Medizinische Klinik und Poliklinik III, Universitätsklinikum der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
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Rachner
Experimentelle und Klinische Osteologie, Lehrstuhl Orthopädie, Universität Würzburg, Würzburg, Deutschland.
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Jakob
Bereich Endokrinologie/Diabetes/Metabolische Knochenerkrankungen, Medizinische Klinik und Poliklinik III, Universitätsklinikum der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland. lorenz.hofbauer@uniklinikum-dresden.de.
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Hofbauer
D000970:Antineoplastic Agents / Q000008:administration & dosage*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D050071:Bone Density Conservation Agents / Q000008:administration & dosage*; D001859:Bone Neoplasms / Q000175:diagnosis / Q000556:secondary* / Q000628:therapy*; D059186:Chemoradiotherapy, Adjuvant / Q000379:methods*; D003131:Combined Modality Therapy / Q000379:methods; D000069448:Denosumab / Q000008:administration & dosage; D019583:Dose Fractionation, Radiation; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D019317:Evidence-Based Medicine; D006801:Humans; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D050071:Bone Density Conservation Agents; D000069448:Denosumab
Breast cancer; Denosumab; Osteoblasts; Osteoclasts; Prostate cancer