New and emerging therapies for bone metastases in genitourinary cancers.

Journal Article (Journal Article;Review)

CONTEXT: Bone metastases are a common feature of advanced genitourinary malignancies and a prominent cause of morbidity and mortality. OBJECTIVE: The objective of this review is to discuss the incidence, pathophysiology, and management of bone metastases in the most prevalent genitourinary malignancies. EVIDENCE ACQUISITION: We reviewed the relevant medical literature, with a particular emphasis on prospective randomized controlled trials. Much of the relevant clinical trial data focus on prostate cancer (PCa). We provide a nonsystematic review and our perspective on the available data. EVIDENCE SYNTHESIS: Clinical manifestations can include pain, hypercalcemia, pathologic fractures, and spinal cord compression. Optimal systemic therapy for skeletal metastases often features a combination of disease-specific therapy and bone-targeted therapy. Some agents, such as the radiopharmaceutical radium-223, blur the line between those categories. Osteoclast inhibition is a validated strategy in the management of selected patients with bone metastases. Zoledronic acid, a bisphosphonate, is approved for the prevention of skeletal events caused by solid tumors metastatic to bone. Denosumab is a fully human monoclonal antibody that inactivates receptor activator of nuclear factor-κB ligand and is approved for the same indication. Beta-emitting radiopharmaceuticals can be effective for the palliation of pain caused by bone metastases, but their use is often limited by marrow suppression. The alpha-emitting radiopharmaceutical radium-223 has recently been shown to improve overall survival and prevent skeletal events in select men with castration-resistant PCa metastatic to bone. Multiple ongoing clinical trials are designed to examine the potential for therapeutic inhibition of additional targets such as Src and hepatocyte growth factor (MET). CONCLUSIONS: Bone metastases cause considerable morbidity and mortality among patients with genitourinary malignancies. Optimal management requires consideration of bone-targeted therapy as well as disease-specific therapy. Further research is needed to optimize the use of existing agents and to define the therapeutic potential of novel targets.

Full Text

Duke Authors

Cited Authors

  • Saylor, PJ; Armstrong, AJ; Fizazi, K; Freedland, S; Saad, F; Smith, MR; Tombal, B; Pienta, K

Published Date

  • February 2013

Published In

Volume / Issue

  • 63 / 2

Start / End Page

  • 309 - 320

PubMed ID

  • 23201471

Pubmed Central ID

  • PMC3661203

Electronic International Standard Serial Number (EISSN)

  • 1873-7560

Digital Object Identifier (DOI)

  • 10.1016/j.eururo.2012.10.007


  • eng

Conference Location

  • Switzerland