Bisphosphonate actions on cancer

Bisphosphonates (BPs) suppress cancer cell colonization in bone associated with cancers such as breast cancer and multiple myeloma. The mechanism of the suppressive action of BPs is thought to be due to an inhibition of osteoclastic bone resorption which releases bone-stored growth factors that feed cancer cells colonizing bone. Recently, data are accumulating that BP suppresses growth and induces apoptosis in cancer cells in culture, suggesting that BP directly influences survival of cancer cells in an osteoclast-independent manner. These results raise the possibility that BP inhibits cancer growth in organs other than bone. However, evidence is limited that BP reduces tumor growth in non-bone sites in cancer patients. In this review, we discuss the effectiveness of BP on breast cancer colonization in non-bone sites and our results in animal models with metastases. With currently available clinical and in vivo experimental data, BPs are definitely beneficial for the treatment of cancer patients who manifest clinically detectable bone metastases. However, it is not recommended that BP be given as a preventative to patients with visceral metastases and of no evidence of bone metastases. Whether individual BP with different chemical structure has unique biological or biochemical action is an intriguing question but open at the moment.