Biology of Bone Metastases
As the mechanisms involved in bone metastases are further elucidated and the pathways involving many of the previously noted molecules are more clearly understood, the clinical applications of this knowledge can have a significant impact. As previously mentioned, treatment for bone metastases, including surgery, radiation and bone-modifying agents such as bisphosphonates and denosumab, have been palliative in nature, attempting to slow disease progression, palliate symptoms, and increase survival. Some of the molecules are diseasespecific, but many appear to be part of a final common pathway that directly increases the number and activity of osteoclasts leading to bone destruction. The development of targeted agents for specific molecules in this final common pathway, as evidenced by denosumab and the RANKL pathway, has the potential to not only palliate but also possibly prevent the development of bone metastases and prolong patient survival.
Clinical Applications
As the mechanisms involved in bone metastases are further elucidated and the pathways involving many of the previously noted molecules are more clearly understood, the clinical applications of this knowledge can have a significant impact. As previously mentioned, treatment for bone metastases, including surgery, radiation and bone-modifying agents such as bisphosphonates and denosumab, have been palliative in nature, attempting to slow disease progression, palliate symptoms, and increase survival. Some of the molecules are diseasespecific, but many appear to be part of a final common pathway that directly increases the number and activity of osteoclasts leading to bone destruction. The development of targeted agents for specific molecules in this final common pathway, as evidenced by denosumab and the RANKL pathway, has the potential to not only palliate but also possibly prevent the development of bone metastases and prolong patient survival.