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A review of 30 studies finds that a class of drugs called bisphosphonates is beneficial in breast cancer patients whose cancer has spread to the bone. Bone is one of the most common sites to which breast cancer can metastasize, or spread. The study finds that bisphosponates can reduce complications in breast cancer patients whose cancer has affected the bone. Therefore, the researchers conclude that these drugs should be considered as soon as breast cancer has spread to the bone to maximize the benefit of treatment. When breast cancer spreads past the breast and axillary (armpit) lymph nodes, it often spreads first to the bone. These breast cancer tumors in the bone are called "bone metastases." As advanced breast cancer dissolves portions of bone, a variety of problems can occur. Bone metastases can cause pain, decreased activity, and potentially severe problems such as fractures. Other complications that can arise from bone metastases include the surgical treatment for fractures, hypercalcemia (abnormally high levels of calcium), and spinal cord compression (vertebral damage due to pressure on the spinal cord). A group of drugs called bisphosphonates are currently used to help treat osteoporosis, a degenerative bone disease affecting mainly post-menopausal women. In patients with osteoporosis, the bone loses a significant portion of its density, greatly increasing the risk of serious fractures. One bisphosphonate, Aredia (genetic name, pamidronate disodium), has already been approved by the U.S. Food and Drug Administration (FDA) to help treat bone metastases caused by breast cancer while a number of other bisphosphonates are currently under investigation for this use. Aredia is administered intravenously (through a vein) along with other cancer treatments, such as chemotherapy. Clinical studies have shown that breast cancer patients with bone metastases who are given Aredia tend to experience a delay in or reduction of bone pain, fractures, and other bone complications compared to patients who do not receive Aredia. Possible side effects of Aredia include fever, fatigue, nausea and vomiting, initial bone pain, lack of appetite, and anemia (decrease in red blood cells). In the current study, Joy Ross, a research fellow at the Royal Marsden Hospital in London, England, and colleagues reviewed 30 published reports on bisphosphonate use in breast cancer patients whose cancer had spread to the bone. In the reports, patients treated with bisphosphonates were compared to others who were treated with another bisphosphonate, a placebo (or inactive pill), or standard care. The results of their analysis showed that women who were treated with bisphosphonates had fewer skeletal complications from breast cancer compared to women who did not receive bisphosphonates. Therefore, the researchers conclude that bisphosphonates should be given to breast cancer patients whose cancer has spread to the bone. According to Ross and colleagues, treatment should continue until no longer needed. Previous studies reveal that further research is needed before all types of bisphosphonates can be recommended for use in breast cancer patients. Types of bisphosphonates under investigation for treating bone metastases include:
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