Journal of Bone Research
Open Access

Bone Metastasis Treatment and Consequences

^*Correspondence: Mark Boldin, Department of Molecular and Cellular Biology, Beckman Research Institute, California, USA, Email:

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Description

For cancer patients, bone metastasis is tragic because, just in the United States, 350,000 people every year pass away from this disease's progression. Additionally, the median survival time of patients with bone metastases in prostate and breast cancer, both of which are known to spread to the bone, is 25 and 27 months, respectively, with current cancer patients being considered incurable when they have bone metastasis. However, due to comorbidities known as Skeletal Related Events (SRE), bone metastases damage patients' quality of life in addition to being incurable. Reduced activity and a lower quality of life are the results of these SREs, which also include severe pain, hypercalcemia, neurological impairments, pathological bone fractures, and spinal cord compression. Treatment plans to stop bone metastases are therefore essential to instantly lower the mortality and morbidity of cancer patients as well as to enhance patient wellbeing.

When compared to treatments for other metastases, therapy approaches for bone metastases are rather uncommon. Treatment plans for primary and secondary tumors are typically similar in situations of cancer metastasis, and they either target the tumors directly or activate the immune system that surrounds them. However, for bone metastases, the treatment approaches prioritize bone function (an organ that continuously modifies itself throughout life by coupling osteoclast and osteoblast activity in a process called bone remodeling). It is known that in the bone microenvironment, the cells involved in bone remodeling, such as osteoclasts, osteoblasts, and osteocytes, interact with cancer cells that have spread to other parts of the body. A "vicious cycle of bone metastasis" is created in this situation when metastatic cells and cells associated with the bone interact, promoting additional bone metastatic advancement. Therefore, it makes sense for therapeutic approaches to focus on how bone remodeling interacts in order to break this vicious cycle.

Drugs that reduce osteoclastic activity are frequently administered in clinics as therapy to help break the cycle of bone metastases. Bisphosphonates and denosumab, a human monoclonal anti-Receptor Activator of Nuclear factor B Ligand RANKL) antibody, are the two that are most frequently recommended. Although some of the unpleasant side effects of bone metastases are lessened by these treatments, they ultimately fall short of increasing patient survival rates. Clinical trials suggest that an alpha particle-emitting radiopharmaceutical, radium-223 dichloride (223RaCl2), can improve overall survival of prostate cancer patients with bone metastases, but only by a few months (mean=3 months) when targeting hydroxyapatite or osteoblastic bone metastatic lesions. Notably, this is the only bone-targeted therapy available that has been shown to prolong patient survival in cases of bone metastatic cancer to yet. While numerous combinations of systemic medications (such as hormone therapies and chemotherapies) are known to boost patients' overall survival, they also only extend survival in patients with bone metastasis by a few months. Therefore, eliminating bone metastases poses one of the biggest challenges in contemporary medicine.

The complex interactions between bone metastatic cancer cells and the bone marrow microenvironment, which contains a variety of cell types, including cells of hematopoietic and mesenchymal origin, with diverging temporal dynamics, are one of the factors contributing to the difficulties in developing treatments for bone metastasis. As previously indicated, these interactions facilitate the vicious cycle of bone metastasis, in which bone metastatic cancer cells encourage osteolytic and/or osteoblastic activities of bone cells to produce space or growth factors for bone metastatic cancer cells to colonise the bone marrow. The increased blood flow in the red marrow and the synthesis of angiogenic factors, which supply enough nutrients to maintain the survival of bone metastatic cancer cells, are additional ways that the bone marrow microenvironment promotes bone metastatic progression. To combine the current knowledge of cancer metastasis with cutting-edge ideas in the bone marrow microenvironment in order to increase the understanding of bone metastasis as a result of these complexityadding factors. The overarching objective of this knowledge integration is to enhance clinical outcomes and treatment plans while lessening the financial burden on patients and their families.