November 2001

Dear Readers: Here's the Article for this Month:

Name of article:Metastatic bone disease:
Clinical features, pathophysiology and treatment stategies.

Author: R.E. Coleman

Reference: Cancer treatment reviews 2001; 27: 165-176


Abstract:

Metastastic bone disease develops as a result of the many interactions between tumour cell and bone cells. This leads to disruption of normal bone metabolism, with the increased osteoclast activity seen in most, if not all, tumor types providing rational target for treatment. The clinical course of metastatic bone disease in multiple  myeloma, breast and prostate cancers is relatively long, with patients experiencing sequential skeletal complications over a period of several years.
These include bone pain, fractures, hypercalcemia and spinal cord compression, all of which may profoundly impair a patient's quality of life. External beam radiotherapy and systemic endocrine and cytotoxic treatments are the mainstay of treatment in advanced cancers. However, it is now clear that the bisphosphonates provide an additional treatment strategy, which reduces both the symptoms and complications of bone involvement. Ongoing research is aimed at trying to define the optimum route, dose, schedule and type of bisphosphonates in metastatic bone disease and in the prevention and treatment of osteoporosis in cancer patients.
In vitro suggestions of direct anticancer activity and some promising clinical data in early breast cancer have resulted in considerable interest in the possible adjuvant use of bisphosphonates to inhibit the development of bone metastases.I selected this article for the following reasons:Bone metastases are present in 65% of patients with advanced neoplastic disease and most of these present a rather slow clinical course characterized by pain (and particularly movement-related pain difficult to control), poor mobility, and skeletal complications such as fractures and spinal cord compression. Coleman reviewed the incidence, causes, clinical features, prevention and the various treatment strategies to manage bone metastases as well as related symptoms such as hypercalcemia and  pain.

Regards,

Carla Ripamonti, MD
Member of the Board of Directors, IAHPC