Bone matters in lung cancer

Abstract

Background: Bone metastases are a significant and undertreated clinical problem in patients with advanced lung cancer.

Design: We reviewed the incidence of bone metastases and skeletal-related events (SREs) in patients with lung cancer and examined the burden on patients' lives and on health care systems. Available therapies to improve survival and lessen the impact of SREs on quality of life (QoL) were also investigated.

Results: Bone metastases are common in lung cancer; however, owing to short survival times, data on the incidences of SREs are limited. As with other cancers, the costs associated with treating SREs in lung cancer are substantial. Bisphosphonates reduce the frequency of SREs and improve measures of pain and QoL in patients with lung cancer; however, nephrotoxicity is a common complication of therapy. Denosumab, a recently approved bone-targeted therapy, is superior to zoledronic acid in increasing the time to first on-study SRE in patients with solid tumours, including lung cancer. Additional roles of bone-targeted therapies beyond the prevention of SREs are under investigation.

Conclusions: With increasing awareness of the consequences of SREs, bone-targeted therapies may play a greater role in the management of patients with lung cancer, with the aim of delaying disease progression and preserving QoL.

Figure 1

Cancer-related mortality in the European Union in 2008. Data represent estimated numbers of cancer deaths in females and males across all ages (total deaths = 1 234 303). Data from GLOBOCAN 2008 v1.2 [1].

Figure 2

Overview of the occurrence of SREs in patients with NSCLC. (A) Data from the placebo arm of a large clinical trial including patients with NSCLC (Rosen et al. 2004 [28]) and two retrospective audits of patients with NSCLC in Japan (Tsuya et al. 2007 [32] and Sekine et al. 2009 [30]). (B) Data from a retrospective audit of 273 patients with NSCLC and bone metastases in Korea [31]. NSCLC, non-small-cell lung cancer; SRE, skeletal-related event.

Figure 3

Estimated costs of skeletal complications in patients with lung cancer by (A) type of SRE and (B) type of service. Values are in US$. Data are based on Kaplan–Meier-estimated costs of SRE-related care in patients with bone metastases arising from lung cancer who experienced at least one SRE (n = 295) [42]. In (A), ‘other’ includes opiods/nonsteroidal anti-inflammatory drugs (US$133), physical medicine (US$115), spinal cord compression (US$77) and non-operative treatment of fractures (US$71). In (b), ‘other’ includes skilled nursing (US$174), outpatient pharmacy (US$133), emergency room visit (US$60), home health (US$25) and laboratory-associated costs (US$1). Figure reproduced from Delea et al. 2004 [42] with permission from S. Karger AG, Basel.