دانلود رایگان مقاله انگلیسی روش های درمانی برای حفاظت از سلامت استخوان در بیماران مبتلا به سرطان پستان - الزویر 2018

abstract

Improvements in the survival of patients with breast cancer, together with a better understanding of the pathology of the disease, have led to the emergence of bone health as a key aspect of patient management. Patients with breast cancer are typically at risk of skeletal complications throughout their disease course. The receptor activator of nuclear factor k B ligand (RANKL) inhibitor denosumab and bisphosphonates (e.g. zoledronic acid) are approved in Europe for the prevention of skeletal-related events (pathologic fracture, radiation or surgery to bone, and spinal cord compression) in adults with bone metastases secondary to solid tumours. These agents are also approved at lower doses for the treatment of patients with postmenopausal osteoporosis, a population largely overlapping with those in the early stages of breast cancer, and those with cancer treatment-induced bone loss, which is caused primarily by aromatase inhibitors. In this review, we consider the evidence supporting the use of therapeutic agents to protect bone health throughout the course of breast cancer. Timing of treatment initiation, dose and treatment duration may prove to be barriers to the optimization of the practical use of these agents in the management of patients with breast cancer. Furthermore, with longer survival times, patients may expect to receive long-term treatment with denosumab or bisphosphonates, therefore consideration must be given to safety. Thus, we aim to summarize the recommendations for the use of these agents in management of patients with breast cancer in Europe. We also discuss the recent evidence for their potential antineoplastic effects.

6. Conclusions

The benefits of denosumab or bisphosphonates in patients with advanced breast cancer relating to reductions in SREs and pain are well known. Patients with early-stage breast cancer can use these agents to treat CTIBL, and recent evidence suggests that there may be a potential survival benefit from the adjuvant use of these drugs. Improving our understanding of the appropriate timing of treatment initiation, treatment duration and dose will be important to ensure that bone health in patients with breast cancer is effectively managed throughout the course of their disease.