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Bone Complications in Lung Cancer

Posted Aug 24 2008 1:49pm
ANNOUNCER: Lung cancer, one of the most common cancers in the U.S., can sometimes spread into other areas of the body, particularly the bone. Today there are new drug treatments available for patients with this added complication.

ROGER WALTZMAN, MD: Skeletal complications arise in any cancer really from hemtogenous spread of disease, which means cells breaking off from a primary tumor site and traveling through the blood stream, which enables them really to travel anywhere. For reasons that are really not clear to the cancer community, the bone is a very common site for cancers to spread.

ROBERT FIGLIN, MD: Lung cancer spreads to the bone in a minority of patients with lung cancer, but when it does so, it can be a major complication of that disease.

ROGER WALTZMAN, MD: If the disease has spread to the bone, then the goal of therapy is palliative care to minimize the complications of the disease and minimize the side effects of both the disease and the therapy.

ANNOUNCER: Pain is usually the first sign that cancer has spread into the bones.

ROGER WALTZMAN, MD: The pain is usually described as a persistent nagging, gnawing moderate or severe discomfort in one particular site of the body

The most important therapy that is almost always used for treatment of pain related to lung cancer metastatic to the bone, is opioid analgesia. Those are the pain medications like morphine and its derivatives.

ROBERT FIGLIN, MD: If you're a patient with a complication of bony metastases, you want to have five points that you ask your doctor. What's the appropriate time for prevention? What's the appropriate time for treatment with pain? What's the appropriate role of radiation therapy? What's the appropriate role of surgery? And what's the appropriate role of chemotherapy or systemic treatment?

ANNOUNCER: One of the systemic treatments available are is a class of drugs called bisphosphonates.

ROGER WALTZMAN, MD: These are drugs that are available primarily intravenously, but also orally and that are commercially available and approved, indicated for metastatic lung cancer to the bone.

ROBERT FIGLIN, MD: The bisphosphonates are potent agents that destroy and ameliorate what is called the osteoclast, which is one of the cells in bones that can destroy bone and create problems, and by destroying that osteoclast, you basically destroy the ability of the cancer to effectively reduce the strength of the bone.

ROGER WALTZMAN, MD: The ones that we most commonly use are called Aredia and Zometa. And these drugs are given intravenously, one for a couple of hours, one for just 15 minutes on about every three or four week basis. And have been demonstrated not to cure the disease to the bone, but to decrease the pain associated with it and to decrease the likelihood of their being further events of new bone disease or fractures from the pre-existing bone disease.

The side effect profile of the two drugs is probably similar, the major problem being potential for kidney toxicity. That's not a common complication, but certainly in someone who may already have impairment of their kidneys, it's something to keep in mind.

ROBERT FIGLIN, MD: Most of us use bisphosphonates to try and prevent the complications from bony metastases, and even though you can't prevent the tumor from growing, you can prevent the tumor's effect on the bone by the use of bisphosphonates.

ANNOUNCER: There are other treatments available for those whose lung cancer has traveled to the bone.

ROGER WALTZMAN, MD: Another strategy is radiopharmaceutical. There are two drugs, one is called Strontium and one is called Samarium. And these are drugs that are injected as well. But they travel to all sites of bone in the body. They have a sort of honing mechanism to go to the bone where that compound is taken up primarily. And that can be a very effective therapy for preventing pain in the bone as well, but it can also compromise the bone marrow and so it can make the patient's blood counts lower, which are issues that also tend to be relevant for patients with lung cancer.

A temporary therapy that can be used is radiation treatments. So radiation therapy is not a treatment that would go on indefinitely. In fact it's usually a short course of a couple of weeks. But radiation therapy given focally to the one area of the bone that's involved with the disease, is also possible

Radiotherapy is, you can think of it like surgery. It just works in the one spot you send it so radiation therapy is given to one site but you can't give radiation therapy in any practical way to multiple sites all over the body.

ANNOUNCER: While there are various treatment available, bisphosphonates may offer added benefits.

ROGER WALTZMAN, MD: The IV bisphosphonates are very useful because they have few side effects, minimal flu-like symptoms usually and for just a brief period of time. And they're administered fairly easily over maybe 15 minutes or a couple of hours, depending on the drug. And they can also be given, every three to four weeks rather than on a very frequent basis. And they have been demonstrated in a number of clinical trials and a number of studies to show that the incidence of further bone involvement and the incidence of complications related to bone involvement is decreased with their use.

ANNOUNCER: Lung cancer patients, whose disease has progressed to include bone complications, have several options to discuss with their doctor these treatments can help manage their disease and prevent further complications from damaging their quality of life.

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