Cancer treatment-induced bone loss in breast and prostate cancer.

PURPOSE: Bone loss resulting from the treatment of breast and prostate cancer is an emerging problem. Bisphosphonates have a potential role in the prevention of this cancer treatment-induced bone loss (CTIBL). METHODS: Studies evaluating the incidence and prevalence of CTIBL in early breast and prostate cancer patients and trials evaluating the preventative role of bisphosphonates were identified by a search of the PubMed and Cochrane Library databases through the end of March 2008. Reference lists from retrieved articles were cross referenced, and further information was obtained from relevant scientific meetings. RESULTS: Several therapies commonly used in the treatment of women and men with breast and prostate cancers, in particular the aromatase inhibitors (AIs) for breast cancer and androgen deprivation therapy (ADT) for prostate cancer, are associated with significant bone loss and with an increase in fracture risk. The use of bisphosphonates seems to attenuate the bone loss, although the long-term impact remains unclear because of insufficient follow-up. CONCLUSION: Adjuvant endocrine therapy with an AI or androgen deprivation can be considered a risk factor for the development of osteopenia, osteoporosis, and bone fracture, which can be mitigated by appropriate bisphosphonate therapy. Clear identification of risk factors for osteoporosis in individual patients should aid treatment decisions about whether to use bisphosphonates when starting or switching to an AI or ADT. Patients need to be educated about this risk and other measures to avoid this complication, including lifestyle modifications that may benefit their general and bone health.

Treatment of relapsed and refractory myeloma.

Multiple myeloma is a malignancy of plasma cells that remains incurable and almost all patients will eventually require some form of salvage therapy. Increasing insight into the biology of myeloma and the availability of new therapeutic options has resulted in rapid change in its management. Clinical trials have investigated numerous agents and regimens for the treatment of patients with relapsed/refractory myeloma, presenting a host of treatment options. Important questions in determining optimal therapy for patients with relapsed/refractory myeloma include the influence of prior therapy, optimal sequencing of regimens, sequential versus combination use of agents, and the role of cytogenetic and other prognostic factors. This article reviews the literature for the treatment of relapsed/refractory myeloma and considers the ability of the evidence to answer these questions, both for established regimens and newer regimens incorporating thalidomide, bortezomib and lenalidomide.