Article révisé par les pairs
| Résumé : | The current main use of inhibitors of bone resorption, bisphosphonates and denosumab, is the prevention of the complications of bone metastases. Monthly infusions of zoledronic acid, the most potent bisphosphonate, decrease the complication rate of tumor-induced osteolysis by about 40%. Recent controlled double-blind phase III trials have demonstrated the superiority of denosumab against zoledronic acid to decrease skeletal morbidity in patients with bone metastases from breast or prostate cancer, and its noninferiority in a third trial including patients with other solid tumors or myeloma. The overall toxicity was similar between both compounds. It is recommended to start an inhibitor of bone resorption as soon as bone metastases are diagnosed, at least in patients with breast cancer. However, the optimal duration of therapy is unknown and we lack validated criteria to better individualize therapy and to define the place of intermittent treatments or of larger intervals between infusions. Lastly, recent studies indicate that zoledronic acid, but also clodronate, are able to reduce the risk of bone metastases and to prolong survival, at least in postmenopausal patients with breast cancer after surgery. This use of inhibitors of bone resorption in the adjuvant setting is not admitted yet although clinical practice is likely to change in the near future. |
