内容紹介
Pharmacological Treatment for Bone Metastasis
Summary
An objective of improvement of treatment outcomes of cancer is alleviation of bone metastasis that occurs in many types of cancers. Recently, the guidelines for the diagnosis and treatment of bone metastasis were published by the Japanese Society of Medical Oncology in cooperation with other groups. These guidelines are essentially evidence based for the pharmacological treatment of bone metastasis by using bone modifying agents(BMA). Cancer cells inhibit osteoblast formation and promote osteoclast proliferation. Many growth factors that are produced by the bone marrow promote osteoclast proliferation. Furthermore, many growth factors enhance the rate of cancer cell growth. These processes underlie bone metastasis. Evidence for the effectiveness of BMA for the treatment of lung cancer, breast cancer, prostate cancer, multiple myeloma, and other cancers is provided in each section of the guidelines. These guidelines also provide evidence for the suppression of skeletal related events(SRE)in lung, breast, and prostate cancers. With regard to multiple myeloma, the guidelines provide evidence for the improvement of overall survival in addition to that for suppression of SRE. Based on these evidences, the guidelines recommend aggressive treatment with BMA for bone metastasis in such cancers.
要旨
がん薬物療法の治療成績の向上に伴う生存期間の延長により,骨転移を有する症例が日常診療でも増加している。最近,日本臨床腫瘍学会を中心に骨転移診療ガイドラインがまとめられたが,薬物療法に関しては主に骨修飾薬(bone modifying agents: BMA)を中心に,臓器別にエビデンスと推奨度に関して整理,記載されている。骨転移はがん細胞からの造骨阻害因子と溶骨因子により骨芽細胞の造骨低下,破骨細胞による骨吸収亢進,さらには骨基質からの増殖因子のがん細胞へのフィードバックという悪循環を分子メカニズムとして背景にもつ。BMAはこれらのメカニズムを背景に開発されており,日常臨床でもすでに使用されている。BMAを使用する意義について,肺がん,乳がん,前立腺がんについては骨関連事象(skeletal related events: SRE)の抑制に関して,多発性骨髄腫についてはSREに加えて全生存期間の延長に関してのエビデンスが述べられており,積極的なBMAの使用が推奨される。
目次
Summary
An objective of improvement of treatment outcomes of cancer is alleviation of bone metastasis that occurs in many types of cancers. Recently, the guidelines for the diagnosis and treatment of bone metastasis were published by the Japanese Society of Medical Oncology in cooperation with other groups. These guidelines are essentially evidence based for the pharmacological treatment of bone metastasis by using bone modifying agents(BMA). Cancer cells inhibit osteoblast formation and promote osteoclast proliferation. Many growth factors that are produced by the bone marrow promote osteoclast proliferation. Furthermore, many growth factors enhance the rate of cancer cell growth. These processes underlie bone metastasis. Evidence for the effectiveness of BMA for the treatment of lung cancer, breast cancer, prostate cancer, multiple myeloma, and other cancers is provided in each section of the guidelines. These guidelines also provide evidence for the suppression of skeletal related events(SRE)in lung, breast, and prostate cancers. With regard to multiple myeloma, the guidelines provide evidence for the improvement of overall survival in addition to that for suppression of SRE. Based on these evidences, the guidelines recommend aggressive treatment with BMA for bone metastasis in such cancers.
要旨
がん薬物療法の治療成績の向上に伴う生存期間の延長により,骨転移を有する症例が日常診療でも増加している。最近,日本臨床腫瘍学会を中心に骨転移診療ガイドラインがまとめられたが,薬物療法に関しては主に骨修飾薬(bone modifying agents: BMA)を中心に,臓器別にエビデンスと推奨度に関して整理,記載されている。骨転移はがん細胞からの造骨阻害因子と溶骨因子により骨芽細胞の造骨低下,破骨細胞による骨吸収亢進,さらには骨基質からの増殖因子のがん細胞へのフィードバックという悪循環を分子メカニズムとして背景にもつ。BMAはこれらのメカニズムを背景に開発されており,日常臨床でもすでに使用されている。BMAを使用する意義について,肺がん,乳がん,前立腺がんについては骨関連事象(skeletal related events: SRE)の抑制に関して,多発性骨髄腫についてはSREに加えて全生存期間の延長に関してのエビデンスが述べられており,積極的なBMAの使用が推奨される。