Bone health in cancer: ESMO Clinical Practice Guidelines

Coleman, Robert E.; Hadji, Peyman; Body, Jean‐Jacques; Santini, Daniele; Chow, Edward; Terpos, Evangelos; Oudard, Stéphane; Bruland, Øyvind S.; Flamen, Patrick; Kurth, Andreas; Poznak, Catherine Van; Aapro, Matti; Jordan, Karin

doi:10.1016/j.annonc.2020.07.019

Cited by 328 publications

(381 citation statements)

References 44 publications

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“…In 2020, ESMO released clinical practice guidelines about bone health in cancer. Multidisciplinary management including palliative RT, radionuclide therapy, orthopaedic surgery and bone-targeted agents (BTAs)were recommended [27]. D'Oronzo et al found that in patients with BM other than breast or prostate cancer, zoledronate would reduce the incidence of SREs, which were associated with worse survival [28].…”

Section: Discussionmentioning

confidence: 99%

Bone Metastasis in Esophageal Adenocarcinoma and Squamous Cell Carcinoma: A SEER-Based Study

Ya¹,

Xiao²,

Wang³

et al. 2021

Preprint

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Background: Esophageal cancer (EC) is a common worldwide disease with a higher mortality rate. Studies on EC patients with bone metastasis (BM) are rare. Our study focused on the clinicopathological features of EC patients with BM using the Surveillance, Epidemiology and End Results (SEER) database to further explore the risk factors and survival for BM.Methods: According to the inclusion and exclusion criteria, EC patients with BM were extracted from the SEER database from 2010 to 2016. Univariable analysis and multivariable logistic regression were used to study the risk factors for BM. Univariable analysis and multivariable Cox regression were performed to reveal the survival and prognostic factors for BM. The competitive risk model was made to compare the association with BM among causes of death. Propensity score matching (PSM) was used to reduce the bias.Results: A total of 5314 patients were included in this study. Patients with BM had a worse prognosis before and after PSM. Male, middle esophagus, with brain metastasis, without lung metastasis, without liver metastasis were major independent risk factors of BM. Poorly differentiated and undifferentiated, with liver metastasis, with lung metastasis and without chemotherapy were major independent prognostic factors of BM.Conclusions: Compared to patients with other metastatic sites such as liver, brain and lung, patients with BM had a worse prognosis. Our findings provide recommendations about clinical guidelines including examination and treatment for EC patients with BM.

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Section: Discussionmentioning

confidence: 99%

Bone Metastasis in Esophageal Adenocarcinoma and Squamous Cell Carcinoma: A SEER-Based Study

Ya¹,

Xiao²,

Wang³

et al. 2021

Preprint

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“…Palliative radiotherapy is frequently used in the treatment of CIBP, because of the high response rate (around 85%). Drawbacks are the possibility of a pain flare-up and the limited use in multiple painful bone metastases (10). Besides that there are disparities in the access to radiotherapy facilities in high and low-income countries.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, several patients are reluctant to take opioids because of fear to become addicted, or because of the side effects (9). Radiotherapy is another effective treatment strategy for bone pain with a complete pain resolution in approximately 50% of the patients (10). Drawbacks of radiotherapy as treatment option are the time delay, as it takes up to 6 weeks before a maximum treatment effect is obtained (although ≥50% of responders have benefit within 1-2 weeks) and a frequently occurring pain flare-up in the first week after radiotherapy (10,11).…”

Section: Introductionmentioning

confidence: 99%

“…Radiotherapy is another effective treatment strategy for bone pain with a complete pain resolution in approximately 50% of the patients (10). Drawbacks of radiotherapy as treatment option are the time delay, as it takes up to 6 weeks before a maximum treatment effect is obtained (although ≥50% of responders have benefit within 1-2 weeks) and a frequently occurring pain flare-up in the first week after radiotherapy (10,11). In addition, radiotherapy is only feasible in patients with a limited number of painful bone metastases.…”

Section: Introductionmentioning

confidence: 99%

“…The ESMO guideline on bone health in patients with cancer (2020) states that multidisciplinary management (e.g., systemic treatments, radiation therapy, surgery and supportive care) is needed for effective treatment of metastatic bone disease. They suggest radiotherapy as treatment of choice in localized CIBP, but no specific treatment recommendations are made for diffuse CIBP (10). The National Comprehensive Cancer Network (NCCN) guideline on NSCLC and National Institute for Health and Care Excellence (NICE) flowcharts on lung cancer mention radiotherapy as pain relief option in CIBP (16,17).…”

Section: Introductionmentioning

confidence: 99%

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Non-Radiation Based Early Pain Relief Treatment Options for Patients With Non-Small Cell Lung Cancer and Cancer Induced Bone Pain: A Systematic Review

et al. 2020

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Introduction: Cancer induced bone pain (CIBP) is frequent in patients with non-small cell lung cancer (NSCLC). Radiation therapy continues to be the gold standard for treatment of painful bone metastases, however only a limited number of metastases can be irradiated. We evaluated non-radiation based early CIBP relief options in NSCLC through a systematic review. Methods: Systematic review including all prospective articles published between 01-1994 and 06-2020 on Pubmed, Cochrane Library and ClinicalTrials.gov database. Inclusion: nonradiation based trials evaluating CIBP early pain relief options (initially defined as pain score evaluated within two weeks, because of no randomized trials, later inclusion broadened to pain score evaluated within six weeks) in ≥10 NSCLC patients. Radioisotope trials were excluded as these treatments have interactions with systemic anticancer therapy. Results: 188 articles were found; 10 articles (6 randomized controlled (4 double blinded), 1 phase II single-arm, and 3 prospective trials) fulfilled the inclusion criteria. Six of these trials consisted of ≥2 treatment arms, whereas the others were single-arm studies. In total, 554 NSCLC patients were evaluated in these trials. The included trials were very heterogeneous regarding evaluated treatment options, methods of pain measuring, and endpoints. No high-level evidence for specific early pain relief treatment options was found. Discussion: Non-radiation based studies evaluating treatment options to rapidly reduce CIBP in NSCLC are scarce. This systematic review shows that there is no high-level evidence to recommend a specific treatment for early pain relief. Future research should focus on early pain relief treatment options for CIBP in NSCLC.

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Fat Body Mass and Vertebral Fracture Progression in Women With Breast Cancer

Cosentini,

Pedersini,

Di Mauro

et al. 2024

JAMA Netw Open

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ImportanceWomen with early breast cancer (EBC) exposed to aromatase inhibitors (AIs) may experience fragility fractures despite treatment with bone-active drugs. Risk factors for fractures in patients receiving AIs and denosumab have not been explored to date.ObjectivesTo evaluate whether an association exists between dual x-ray absorptiometry (DXA)–measured fat body mass (FBM) and vertebral fracture (VF) progression in postmenopausal women with EBC undergoing adjuvant therapy with AIs in combination with denosumab and to examine whether VF was associated with common risk factors for bone fracture and parameters of body composition other than FBM.Design, Setting, and ParticipantsFor this prospective, single-center, cohort study, 237 patients with EBC who were undergoing adjuvant treatment with AIs and denosumab (60 mg every 6 months) were enrolled at the Breast Unit of the ASST Spedali Civili of Brescia from September 2014 to June 2018. Data analysis was conducted in June 2022.ExposureBody composition parameters, bone mineral density, and morphometric VFs were assessed by DXA at study entry and after 18 months of therapy.Main Outcomes and MeasuresVF progression, defined as either new or worsening of preexisting VFs, between the 2 time points.ResultsOf the 237 patients enrolled (median [range] age, 61 [28-84] years), 17 (4.4%) reported VF progression. Univariable analysis found an association between VF progression and a history of clinical fractures (odds ratio [OR], 3.22; 95% CI, 1.19-8.74; P = .02), Fracture Risk Assessment Tool (FRAX) score for major fractures (OR, 4.42; 95% CI, 1.23-13.79; P = .04), percentage of FBM (OR, 6.04; 95% CI, 1.69-21.63; P = .006), and android fat (OR, 9.58; 95% CI, 1.17-78.21; P = .04) and an inverse association with appendicular lean mass index–FBM ratio (OR, 0.25, 95% CI, 0.08-0.82; P = .02). Multivariable analysis revealed percentage of FBM (OR, 5.41; 95% CI, 1.49-19.59; P = .01) and FRAX score (OR, 3.95; 95% CI, 1.09-14.39; P = .04) as independent variables associated with VF progression.Conclusions and RelevanceThe findings of this study suggest that baseline FBM is an independent factor for VF progression in patients with EBC treated with adjuvant AIs and denosumab. This observation is new and indicates that diet and exercise may synergize with denosumab in the management of bone health in this patient setting.

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Bone health in cancer: ESMO Clinical Practice Guidelines

Cited by 328 publications

References 44 publications

Bone Metastasis in Esophageal Adenocarcinoma and Squamous Cell Carcinoma: A SEER-Based Study

Bone Metastasis in Esophageal Adenocarcinoma and Squamous Cell Carcinoma: A SEER-Based Study

Non-Radiation Based Early Pain Relief Treatment Options for Patients With Non-Small Cell Lung Cancer and Cancer Induced Bone Pain: A Systematic Review

Fat Body Mass and Vertebral Fracture Progression in Women With Breast Cancer

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