Bone metastasis Flashcards
if patient develops bone metastasis, what can you do to decrease the risk for skeletal related events
start denosumab or bisphosphonates
skeletal related events from bone metastasis are:
fracture, skeletal instability and loss and spinal cord compression
what are other benefits of having denosumab and bisphosphonates
they can delay symptom onset, fracture formation, need for irradiation, development of hypercalcemia and possible surgical treatment
what is denosumab?
fully human monoclonal antibody that binds to receptor activator of the nuclear factor Kappa B ligand (RANKL) and prevents its interaction with RANK which helps activate osteoclasts (bone break down cells)
benefit of denosumab
this helps to delay skeletal related events compared to zoledronic acid or palmidronate (bisphosphonate)
can be used with variety of solid tumors
no need for renal adjustments
major side effects of denosumab
osteonecrosis of jaw, hypocalcemia
same as bisphosphonates
what must be done prior to starting therapy for prevention of skeletal related events when someone has boney metastasis?
need to have correction of low Ca and vitamin D deficiency prior to denosumab therapy.
Zoledronic acid should not be used if pts CrCl is
not allowed to be used in CrCl<35
why do we not use alendronate or an oral bisphosphonate for treatment of bone metastasis
ok to use aldendronate for osteoporosis
Cannot use for prevention of skeletal related events in boney metastasis because it has poor bioavailability as PO agent.
Must use IV bisphosphonate.
what is the role of irradiation of boney metastasis?
it helps with bone pain but doesn’t help prevent skeletal related events.
Calcitonin is used for
treatment of Paget’s dx and adjunct in treating hypercacemia but doesn’t improve bone metastases.
