Bone metastases occur frequently in cancer patients and can lead to skeletal-related events (SREs) such as pathological fracture, spinal cord compression, radiation to bone, and surgery to bone. To prevent SREs in patients with bone metastases, bisphosphonates such as zoledronic acid have been used for many years.
In January 2012, denosumab, a fully human monoclonal antibody to RANK ligand, was also approved in Japan for the prevention of SREs. Three pivotal phase 3 trials showed that denosumab was non-inferior to zoledronic acid in reducing the risk of SREs in patients with bone metastases from solid tumors. In patients with breast or prostate cancer, significant superiority of denosumab to zoledronic acid was also shown.
I will discuss how we should manage bone metastases and related complications and how we should use bisphosphonates or denosumab to prevent SREs and to improve or maintain quality of life in patients with bone metastases.