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Bone Metastases

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New Therapeutic Strategies in Lung Cancers

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Abstract

Approximately 30–40 % of patients with advanced lung cancer develop bone metastases. The newer therapies are extending survival and thus increasing further chance of developing bone metastases.

The development of bone metastases causes skeletal-related events (SREs) such as pathologic fractures, spinal cord compression, radiation therapy or surgery to bone, or hypercalcemia with debilitating consequences affecting patients’ health-related quality of life (QOL) and performance status. Poor performance status then prevents the patients to receive further lines of treatments which are available today. SREs are also associated with increased economic costs. In one clinical trial, most patients with bone metastases from non-small cell lung carcinoma (NSCLC) experienced an SRE within the first 5 months on study. Early detection of bone metastases can prevent the development of SREs but also avoids inappropriate implementation of major surgery or aggressive chemoradiation therapy.

With the new generation bisphosphonate zoledronic acid or denosumab (anti-RANKL activity), we can reduce the number of patients who experience at least one SRE, decrease the annual incidence of SREs and delay the median time to first SRE. These agents are effective even after the onset of SREs. They are well tolerated and most of the time the side effects are manageable. The biochemical markers of bone metabolism, especially N-telopeptide of type I collagen (NTX) and bone specific alkaline phosphatase (BALP) can be both prognostic and predictive markers for the patients with bone metastases from NSCLC and guide our decisions regarding their treatments with the new bone targeted agents.

Anticancer activity of both zoledronic acid and denosumab further supports their use as soon as bone metastases are diagnosed as they can contribute to a longer progression free and overall survival in patients with NSCLC. Future trials will inform us about the efficacy of these agents for prevention of bone metastases and possibly even the effects on visceral metastases.

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  1. Department of Medical Oncology, McGill University Health Center, Royal Victoria Hospital, 687 Pine Avenue West, Montreal, H3A 1A1, Canada

    Vera Hirsh

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  1. Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland

    Solange Peters

  2. Pathologie thoracique, Institut Gustave Roussy, Villejuif, France

    Benjamin Besse

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Hirsh, V. (2015). Bone Metastases. In: Peters, S., Besse, B. (eds) New Therapeutic Strategies in Lung Cancers. Springer, Cham. https://doi.org/10.1007/978-3-319-06062-0_15

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