Erken Evre Meme Kanserinde Osteoklast İnhibitörlerinin Kullanımı
Özet
Meme kanseri tedavisi, özellikle premenopozal kadınlarda, over baskılanması, kemoterapiye bağlı over disfonksiyonu veya endokrin tedavi nedeniyle hızlanmış kemik kaybına yol açabilmektedir. Osteoklast inhibitörleri olan bifosfonatlar ve denosumab, osteoporoz ve kırık riskini azaltmakta etkili bulunmuş, ayrıca adjuvan antikanser tedaviler olarak da değerlendirilmiştir. Önleyici stratejiler; yeterli kalsiyum ve D vitamini alımı, ağırlık taşıyan egzersizler ve sağlıklı yaşam tarzı alışkanlıklarını içermelidir. Kırık riski yüksek hastalarda farmakolojik tedavi gerekebilir. Klinik çalışmalar, zoledronik asit, klodronat ve ibandronatın kemik mineral yoğunluğunu (BMD) stabilize ettiğini ve kırık oranlarını azalttığını göstermiştir; denosumab için ise hastalıksız sağkalım açısından sonuçlar çelişkilidir. Adjuvan sistemik tedavi alan ve uzak nüks riski orta ila yüksek olan postmenopozal kadınlarda, zoledronik asit veya klodronat ile adjuvan bifosfonat tedavisi önerilmektedir. Ancak, bu tedavinin mutlak faydası sınırlıdır ve ilaç seçimi etkinlik, güvenlik ve ruhsat durumu göz önünde bulundurularak yapılmalıdır. Tarama ve risk değerlendirmesi klinik değerlendirme ve gerekirse DXA taramasıyla desteklenmelidir. Osteoklast inhibitörlerinin çene osteonekrozu veya atipik kırıklar gibi ciddi yan etkilere yol açabileceği unutulmamalıdır. Tedavi endikasyonlarının netleştirilmesi ve hasta sonuçlarının iyileştirilmesi amacıyla ileri araştırmalara ihtiyaç vardır.
Referanslar
Handforth C, D'Oronzo S, Coleman R, Brown J. Cancer treatment and bone health. Calcif Tissue Int. 2018;102:251.
Coleman R, Hadji P, Body JJ, et al. Bone health in cancer: ESMO clinical practice guidelines. Ann Oncol. 2020;31:1650.
Shapiro CL, Van Poznak C, Lacchetti C, et al. Management of osteoporosis in survivors of adult cancers with nonmetastatic disease: ASCO clinical practice guideline. J Clin Oncol. 2019;37:2916.
National Library of Medicine. A public health approach to promote bone health. Available at: https://www.ncbi.nlm.nih.gov/books/NBK45518/. Accessed November 6, 2024.
Waqas K, Lima Ferreira J, Tsourdi E, et al. Updated guidance on the management of cancer treatment-induced bone loss (CTIBL) in pre- and postmenopausal women with early-stage breast cancer. J Bone Oncol. 2021;28:100355.
SEER Stat Fact Sheets: Breast Cancer. Available at: http://seer.cancer.gov/statfacts/html/breast.html. Accessed November 6, 2024.
Vehmanen L, Elomaa I, Blomqvist C, Saarto T. Tamoxifen treatment after adjuvant chemotherapy has opposite effects on bone mineral density in premenopausal patients depending on menstrual status. J Clin Oncol. 2006;24:675.
Shapiro CL, Manola J, Leboff M. Ovarian failure after adjuvant chemotherapy is associated with rapid bone loss in women with early-stage breast cancer. J Clin Oncol. 2001;19:3306.
Powles TJ, McCloskey E, Paterson AH, et al. Oral clodronate and reduction in loss of bone mineral density in women with operable primary breast cancer. J Natl Cancer Inst. 1998;90:704.
Saarto T, Blomqvist C, Välimäki M, et al. Chemical castration induced by adjuvant cyclophosphamide, methotrexate, and fluorouracil chemotherapy causes rapid bone loss that is reduced by clodronate: a randomized study in premenopausal breast cancer patients. J Clin Oncol. 1997;15:1341.
Delmas PD, Balena R, Confravreux E, et al. Bisphosphonate risedronate prevents bone loss in women with artificial menopause due to chemotherapy of breast cancer: a double-blind, placebo-controlled study. J Clin Oncol. 1997;15:955.
Sverrisdóttir A, Fornander T, Jacobsson H, et al. Bone mineral density among premenopausal women with early breast cancer in a randomized trial of adjuvant endocrine therapy. J Clin Oncol. 2004;22:3694.
Powles TJ, Hickish T, Kanis JA, et al. Effect of tamoxifen on bone mineral density measured by dual-energy x-ray absorptiometry in healthy premenopausal and postmenopausal women. J Clin Oncol. 1996;14:78.
Gnant MF, Mlineritsch B, Luschin-Ebengreuth G, et al. Zoledronic acid prevents cancer treatment-induced bone loss in premenopausal women receiving adjuvant endocrine therapy for hormone-responsive breast cancer: a report from the Austrian Breast and Colorectal Cancer Study Group. J Clin Oncol. 2007;25:820.
Kim M, Kim H, Ahn SH, et al. Changes in bone mineral density during 5 years of adjuvant treatment in premenopausal breast cancer patients. Breast Cancer Res Treat. 2020;180:657.
Reid DM, Doughty J, Eastell R, et al. Guidance for the management of breast cancer treatment-induced bone loss: a consensus position statement from a UK expert group. Cancer Treat Rev. 2008;34 Suppl 1:S3.
Favus MJ. Bisphosphonates for osteoporosis. N Engl J Med. 2010;363:2027.
Body JJ. Prevention and treatment of side-effects of systemic treatment: bone loss. Ann Oncol. 2010;21 Suppl 7:vii180.
Vehmanen L, Saarto T, Risteli J, et al. Short-term intermittent intravenous clodronate in the prevention of bone loss related to chemotherapy-induced ovarian failure. Breast Cancer Res Treat. 2004;87:181.
Fuleihan Gel-H, Salamoun M, Mourad YA, et al. Pamidronate in the prevention of chemotherapy-induced bone loss in premenopausal women with breast cancer: a randomized controlled trial. J Clin Endocrinol Metab. 2005;90:3209.
Vehmanen L, Saarto T, Elomaa I, et al. Long-term impact of chemotherapy-induced ovarian failure on bone mineral density (BMD) in premenopausal breast cancer patients. The effect of adjuvant clodronate treatment. Eur J Cancer. 2001;37:2373.
Shapiro CL, Halabi S, Hars V, et al. Zoledronic acid preserves bone mineral density in premenopausal women who develop ovarian failure due to adjuvant chemotherapy: final results from CALGB trial 79809. Eur J Cancer. 2011;47:683.
Gnant M, Mlineritsch B, Luschin-Ebengreuth G, et al. Adjuvant endocrine therapy plus zoledronic acid in premenopausal women with early-stage breast cancer: 5-year follow-up of the ABCSG-12 bone-mineral density substudy. Lancet Oncol. 2008;9:840.
Ramchand SK, Ghasem-Zadeh A, Hoermann R, et al. Denosumab prevents bone loss and microarchitectural deterioration in premenopausal women with breast cancer receiving estradiol suppression therapy: a randomized controlled trial. J Clin Oncol. 2024;:JCO2302309.
Raisz LG. Clinical practice. Screening for osteoporosis. N Engl J Med. 2005;353:164.
Rosen CJ. Clinical practice. Postmenopausal osteoporosis. N Engl J Med. 2005;353:595.
Van Poznak C, Morris P, D'Andrea G, et al. Bone Mineral Density (BMD) Changes at 1 Year in Postmenopausal Women Who Are Not Receiving Adjuvant Endocrine Therapy for Breast Cancer (BCA). Cancer Res. 2009;69S:SABCS #1066.
Love RR, Mazess RB, Barden HS, et al. Effects of tamoxifen on bone mineral density in postmenopausal women with breast cancer. N Engl J Med. 1992;326:852.
Gralow JR, Biermann JS, Farooki A, et al. NCCN Task Force Report: Bone Health In Cancer Care. J Natl Compr Canc Netw. 2013;11 Suppl 3:S1.
Hadji P, Aapro MS, Body JJ, et al. Management of Aromatase Inhibitor-Associated Bone Loss (AIBL) in postmenopausal women with hormone sensitive breast cancer: Joint position statement of the IOF, CABS, ECTS, IEG, ESCEO IMS, and SIOG. J Bone Oncol. 2017;7:1.
Khan MI. Management of bone loss due to endocrine therapy during cancer treatment. Osteoporos Int. 2023;34:671.
Adams A, Jakob T, Huth A, et al. Bone-modifying agents for reducing bone loss in women with early and locally advanced breast cancer: a network meta-analysis. Cochrane Database Syst Rev. 2024;7:CD013451.
Adams A, Jakob T, Huth A, et al. Bone-modifying agents for reducing bone loss in women with early and locally advanced breast cancer: a network meta-analysis. Cochrane Database Syst Rev. 2024;7:CD013451.
Early Breast Cancer Trialists' Collaborative Group (EBCTCG), Coleman R, Powles T, et al. Adjuvant bisphosphonate treatment in early breast cancer: meta-analyses of individual patient data from randomised trials. Lancet. 2015;386:1353.
O'Carrigan B, Wong MH, Willson ML, et al. Bisphosphonates and other bone agents for breast cancer. Cochrane Database Syst Rev. 2017;10:CD003474.
Wang SF, Lin YS, Yeh WY, et al. The Clinical Benefits of Antiresorptive Agents in Patients with Primary Breast Cancer Receiving Adjuvant Endocrine Therapy: A Systematic Review with Pairwise and Network Meta-analysis. J Clin Endocrinol Metab. 2023;108:e1433.
Mauri D, Valachis A, Polyzos NP, et al. Does adjuvant bisphosphonate in early breast cancer modify the natural course of the disease? A meta-analysis of randomized controlled trials. J Natl Compr Canc Netw. 2010;8:279.
Valachis A, Polyzos NP, Coleman RE, et al. Adjuvant therapy with zoledronic acid in patients with breast cancer: a systematic review and meta-analysis. Oncologist. 2013;18:353.
Vliek SB, Noordhoek I, Meershoek-Klein Kranenbarg E, et al. Daily Oral Ibandronate With Adjuvant Endocrine Therapy in Postmenopausal Women With Estrogen Receptor-Positive Breast Cancer (BOOG 2006-04): Randomized Phase III TEAM-IIB Trial. J Clin Oncol. 2022;40:2934.
Eisen A, Somerfield MR, Accordino MK, et al. Use of Adjuvant Bisphosphonates and Other Bone-Modifying Agents in Breast Cancer: ASCO-OH (CCO) Guideline Update. J Clin Oncol. 2022;40:787.
Desnoyers A, Amir E, Tannock IF. Adjuvant Zoledronate Therapy for Women With Breast Cancer-Effective Treatment or Fool's Gold? JAMA Oncol. 2021;7:1121.
Dhesy-Thind S, Fletcher GG, Blanchette PS, et al. Use of Adjuvant Bisphosphonates and Other Bone-Modifying Agents in Breast Cancer: A Cancer Care Ontario and American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol. 2017;35:2062.
Breast. National Comprehensive Cancer Network. Available at: https://www.nccn.org/professionals/physician_gls/pdf/breast.pdf. Accessed November 13, 2024.
Jacobs C, Amir E, Paterson A, et al. Are adjuvant bisphosphonates now standard of care of women with early stage breast cancer? A debate from the Canadian Bone and the Oncologist New Updates meeting. J Bone Oncol. 2015;4:54.
McGee S, Alzahrani M, Vandermeer L, et al. Adjuvant bisphosphonate use in patients with early stage breast cancer: a physician survey. Breast Cancer Res Treat. 2021;187:477.
McGee S, AlZahrani M, Stober C, et al. Adjuvant bisphosphonate use in patients with early stage breast cancer: Patient perspectives on treatment acceptability and potential de-escalation. J Bone Oncol. 2021;27:100351.
Stopeck AT. Osteoclast inhibition in postmenopausal breast cancer: Is the evidence too strong to ignore? Cancer. 2017;123:2392.
American Society of Clinical Oncology (ASCO). The ASCO Post: Denosumab prevents neither breast cancer relapse nor death. Available at: https://ascopost.com/issues/june-25-2019/denosumab-prevents-neither-breast-cancer-relapse-nor-death/. Accessed November 6, 2024.
Gnant M, Pfeiler G, Steger GG, et al. Adjuvant denosumab in postmenopausal patients with hormone receptor-positive breast cancer (ABCSG-18): disease-free survival results from a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Oncol. 2019;20:339.
Gralow JR, Barlow WE, Paterson AHG, et al. Phase III Randomized Trial of Bisphosphonates as Adjuvant Therapy in Breast Cancer: S0307. J Natl Cancer Inst. 2020;112:698.
von Minckwitz G, Möbus V, Schneeweiss A, et al. German adjuvant intergroup node-positive study: a phase III trial to compare oral ibandronate versus observation in patients with high-risk early breast cancer. J Clin Oncol. 2013;31:3531.
Hadji P, Coleman RE, Wilson C, et al. Adjuvant bisphosphonates in early breast cancer: consensus guidance for clinical practice from a European Panel. Ann Oncol. 2016;27:379.
Coleman RE, Finkelstein D, Barrios CH, et al. Adjuvant denosumab in early breast cancer: First results from the international multicenter randomized phase III placebo controlled D-CARE study. J Clin Oncol. 2018;36S:ASCO #501.
Coleman R, Finkelstein DM, Barrios C, et al. Adjuvant denosumab in early breast cancer (D-CARE): an international, multicentre, randomised, controlled, phase 3 trial. Lancet Oncol. 2020;21:60.
Gnant M, Frantal S, Pfeiler G, et al. Long-Term Outcomes of Adjuvant Denosumab in Breast Cancer. NEJM Evid. 2022;1:EVIDoa2200162.
Clark EM, Durup D. Inflammatory eye reactions with bisphosphonates and other osteoporosis medications: what are the risks? Ther Adv Musculoskelet Dis. 2015;7:11.
Cummings SR, Ferrari S, Eastell R, et al. Vertebral Fractures After Discontinuation of Denosumab: A Post Hoc Analysis of the Randomized Placebo-Controlled FREEDOM Trial and Its Extension. J Bone Miner Res. 2018;33:190.
Mauri D, Valachis A, Polyzos IP, et al. Osteonecrosis of the jaw and use of bisphosphonates in adjuvant breast cancer treatment: a meta-analysis. Breast Cancer Res Treat. 2009;116:433.
Rathbone EJ, Brown JE, Marshall HC, et al. Osteonecrosis of the jaw and oral health-related quality of life after adjuvant zoledronic acid: an adjuvant zoledronic acid to reduce recurrence trial subprotocol (BIG01/04). J Clin Oncol. 2013;31:2685.
