Prevention and Treatment of Bone Metastases from Breast Cancer

Dear Colleagues,

Bone metastases are common in advanced breast cancer and cause considerable morbidity. They result from the interactions between cancer cells in the bone marrow microenvironment, haematopoietic stem cells and normal bone cells. Bone-targeted treatments may modify the course of the disease via inhibitory effects on this “vicious cycle” of growth factor and cytokine signalling between tumour and bone cells within the bone marrow micro-environment. Improvements in both disease free and overall survival in women with early breast cancer have been demonstrated with oral clodronate and in several large randomised adjuvant trials of zoledronic acid. The evidence for this is particularly strong in patients with low levels of reproductive hormones including premenopausal women receiving ovarian suppression therapy and those who have passed through menopause at the time of diagnosis. Bone-targeted agents, including bisphosphonates and denosumab, are an important component of management in advanced malignancy. Combined with systemic cancer therapy, effective symptom control and appropriate surgical and radiological interventions, modern multi-disciplinary care has transformed the care of patients with metastatic bone disease.

These reviews will cover the following important topics spanning clinical and translational cancer medicine:

• Mechanisms of metastasis
• Adjuvant therapy to prevent bone metastases
• Bone targeted treatments for the management of bone metastases
• Radiotherapy and radioisotopes for the treatment of bone metastases
• Imaging for diagnosis and monitoring of bone metastases

Prof. Dr. Robert Coleman
Guest Editor

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