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Systemic Treatment of Bone Disease in Metastatic Urinary Malignancies
Sunil H Patel1, Justine Panian1, Kelly Bree1
1San Diego, CA, USA.
Context:
Bone metastasis is a common site of metastatic disease in patients with genitourinary malignancies. Given that the presence of bone metastasis decreases survival and has a negative impact on quality of life impact, it is critical to optimize management of this patient population.
Objective:
To systematically review literature on the systemic treatment of bone metastasis in prostate cancer, renal cell carcinoma, urothelial carcinoma, and germ cell tumors.
Evidence Acquisition:
We performed a nonsystematic critical review of PubMed/Medline, clinicaltrials.gov, and the Cochrane Library from January 2001 to February 2019. Identified reports were reviewed according to the Consolidated Standards of Reporting Trials, and selected based on reporting skeletal related events and symptomatic skeletal events for patients with urologic malignancies.
Evidence Synthesis:
Skeletal metastases occur frequently in genitourinary malignancies, at rates around 80% for patients with metastatic prostate cancer and 30% for patients with metastatic renal cell and urothelial carcinoma, and are uncommon in patients with germ cell tumors. Skeletal related events and symptomatic skeletal events can occur in these patients. Optimization of bone health involves dietary and lifestyle modifications, and use of osteoclast-targeted agents in select individuals. Additionally, disease-modifying agents, such as radiopharmaceutical, immunotherapy, and cMET inhibitors, which have activity in the bone, have improved outcomes for patients, including skeletal-related events and symptomatic skeletal events.
Conclusions:
While the presence of bone metastases is associated with increased mortality and worse outcomes in patients with genitourinary malignancies, strategies have been developed to improve quality of life and survival for patients with skeletal metastases. Future studies investigating novel therapeutic options and bone supporting agents are warranted to target this patient population.
Patient Summary:
In this report, we reviewed the current literature and recent clinical trials involving treatment of bone metastases in urinary cancers. The use of bone-targeting agents can improve outcomes for patients, and additional lifestyle modification can optimize bone health in this population.
Insights
Optimizing bone health in genitourinary cancers with bone metastases is crucial. Systemic treatments and bone-targeting agents improve survival and quality of life for patients with skeletal metastases.
Area of Science:
- Oncology
- Genitourinary Malignancies
- Bone Metastasis Management
Background:
- Bone metastasis significantly impacts survival and quality of life in genitourinary cancers.
- Prostate, renal cell, and urothelial carcinomas frequently metastasize to bone.
- Bone metastases are less common in germ cell tumors but still impact patient outcomes.
Purpose of the Study:
- To systematically review literature on systemic treatments for bone metastasis in genitourinary malignancies.
- To evaluate current management strategies for bone metastases in prostate, renal cell, urothelial, and germ cell cancers.
- To identify treatments that improve skeletal-related events and overall survival.
Main Methods:
- Nonsystematic critical review of PubMed/Medline, clinicaltrials.gov, and Cochrane Library (Jan 2001-Feb 2019).
- Selection of reports based on Consolidated Standards of Reporting Trials criteria.
- Focus on skeletal-related and symptomatic skeletal events in urologic malignancies.
Main Results:
- Skeletal metastases are common, particularly in prostate cancer (approx. 80%).
- Osteoclast-targeted agents, radiopharmaceuticals, immunotherapy, and cMET inhibitors improve outcomes.
- Disease-modifying agents with bone activity enhance survival and reduce skeletal events.
Conclusions:
- Bone metastases worsen mortality and outcomes in genitourinary cancers.
- Current strategies, including bone-targeting agents and lifestyle modifications, improve quality of life and survival.
- Further research into novel therapies and bone support agents is essential for this patient population.
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