Bone mets - articles sent to 2nd Sis-in-law

[Jackie07]

Hi,

Just heard from my 2nd Sister that our 2nd Sister-in-law (wife of 2nd Brother) is going to have a hip surgery for bone mets. She's just two years younger than me (49?).

I think 2nd Sister-in-law was diagnosed right after my recurrence in 2007 (2008?). Being the only one living in the States, plus having had a couple of major illnesses, I'm usually kept in the dark of any 'bad' news of my family. The Chinese has a tradition not to bring bad news to a person who's recuperating. A person who's just attended a funeral is not supposed to visit anyone in the hospital... etc.

Found a couple of articles on the subject and thought I would share them here with my Her2 sisters:

Breast cancer bone metastasis:
Clin Calcium. 2011;21(3):429-438.
[Encounter of cancer cells with bone. Treatment of bone metastases from breast cancer.]
[Article in Japanese]
Taguchi T.
Department of Endocrine and Breast Surgery, Kyoto Prefectural University of Medicine.
Abstract
In metastatic breast cancer the most common metastatic site is bone. Skeletal-related events (SREs) as well as bone pain are well-known characteristics of bone metastasis. Activation of osteoclast is the most important mechanism for the progression of bone metastasis. To treat bone metastasis, not only administration of antitumor drug but also inhibition of osteoclast activity should be required. Bisphosphonates, as potent inhibitors of osteoclast function, reduce the morbidity of metastatic bone disease, decrease the prevalence of SREs, and improve control of bone pain. Molecular targeted agents which inhibit maturity and activity of osteoclast are under development, and some effectiveness has been proved in clinical trials. Long-term survival just like good control of a symptom is expected in future by using new drugs specific to bone metastasis as part of multidisciplinary approach.

J Clin Oncol. 2011 Feb 22. [Epub ahead of print]
American Society of Clinical Oncology Executive Summary of the Clinical Practice Guideline Update on the Role of Bone-Modifying Agents in Metastatic Breast Cancer.
Van Poznak CH, Temin S, Yee GC, Janjan NA, Barlow WE, Biermann JS, Bosserman LD, Geoghegan C, Hillner BE, Theriault RL, Zuckerman DS, Von Roenn JH.
University of Michigan, Ann Arbor, MI; American Society of Clinical Oncology, Alexandria; Virginia Commonwealth University, Richmond, VA; University of Nebraska Medical Center, Omaha, NE; Cancer Research and Biostatistics, Seattle, WA; Wilshire Oncology Medical Group, Rancho Cucamonga, CA; Y-ME National Breast Cancer Organization; Lurie Comp Cancer Center of Northwestern University, Chicago, IL; National Center for Policy Analysis, Dallas; The University of Texas MD Anderson Cancer Center, Houston, TX; and Mountain States Tumor Institute, Boise, ID.
Abstract
PURPOSE To update the recommendations on the role of bone-modifying agents in the prevention and treatment of skeletal-related events (SREs) for patients with metastatic breast cancer with bone metastases. METHODS A literature search using MEDLINE and the Cochrane Collaboration Library identified relevant studies published between January 2003 and November 2010. The primary outcomes of interest were SREs and time to SRE. Secondary outcomes included adverse events and pain. An Update Committee reviewed the literature and re-evaluated previous recommendations. Results Recommendations were modified to include a new agent. A recommendation regarding osteonecrosis of the jaw was added. Recommendations Bone-modifying agent therapy is only recommended for patients with breast cancer with evidence of bone metastases; denosumab 120 mg subcutaneously every 4 weeks, intravenous pamidronate 90 mg over no less than 2 hours, or zoledronic acid 4 mg over no less than 15 minutes every 3 to 4 weeks is recommended. There is insufficient evidence to demonstrate greater efficacy of one bone-modifying agent over another. In patients with a calculated serum creatinine clearance of more than 60 mg/min, no change in dosage, infusion time, or interval of bisphosphonate administration is required. Serum creatinine should be monitored before each dose. All patients should receive a dental examination and appropriate preventive dentistry before bone-modifying agent therapy and maintain optimal oral health. Current standards of care for cancer bone pain management should be applied at the onset of pain, in concert with the initiation of bone-modifying agent therapy. The use of biochemical markers to monitor bone-modifying agent use is not recommended.

[Jackie07]

Also sent two abstracts on Alzheimer's Disease - 96-year-old Dad has been 'hearing' mosquitos flying around him and 'seeing' (up to) 14 'bad people' standing around. A doctor prescribed medicine for Alzheimer's.

Eur Neurol. 2010;64(6):337-44. Epub 2010 Nov 13.
Improved visual hallucination by donepezil and occipital glucose metabolism in dementia with Lewy bodies: the Osaki-Tajiri project.
Satoh M, Ishikawa H, Meguro K, Kasuya M, Ishii H, Yamaguchi S.
Department of Geriatric Behavioral Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan.
Abstract
Deficits in the cholinergic system are pronounced in dementia with Lewy bodies (DLB) and are more severe in patients with visual hallucinations (VHs). The aim is to identify the occipital glucose metabolism patterns by positron emission tomography (PET) and the changes following donepezil treatment. 13 DLB patients with VHs were enrolled in the study. After the first FDG-PET study, 5 mg/day donepezil was administered orally, and a second PET study was performed 3 months later. After donepezil administration, VHs disappeared completely in 6 patients, and the PET studies revealed significantly decreased glucose metabolism in the medial occipital cortex. These results suggest that VHs in DLB were associated with impaired glucose metabolism in the medial occipital cortex. Donepezil treatment may modify regional glucose metabolism. 後腦頁葡萄糖代謝問題造成的幻聽這個藥可以改善局部的葡萄糖代謝 (吸收)功能
Copyright 2010 S. Karger AG, Basel.
Am J Geriatr Psychiatry. 2010 Nov;18(11):1026-35.
Neuropsychiatric symptoms and syndromes in a large cohort of newly diagnosed, untreated patients with Alzheimer disease.
Spalletta G, Musicco M, Padovani A, Rozzini L, Perri R, Fadda L, Canonico V, Trequattrini A, Pettenati C, Caltagirone C, Palmer K.
Fondazione Santa Lucia, Instituto di Ricovero e Cura a Carettere Scientifico, Rome, Italy.
Abstract
OBJECTIVES: Neuropsychiatric symptoms are common in patients with Alzheimer disease (AD). Treatment for both AD and psychiatric disturbances may affect the clinical observed pattern and comorbidity. The authors aimed to identify whether particular neuropsychiatric syndromes occur in untreated patients with AD, establish the severity of syndromes, and investigate the relationship between specific neuropsychiatric syndromes and AD disease severity.
DESIGN: Cross-sectional, multicenter, clinical study.
PARTICIPANTS: A total of 1,015 newly diagnosed, untreated outpatients with AD from five Italian memory clinics were consecutively enrolled in the study from January 2003 to December 2005.
MEASUREMENTS: All patients underwent thorough examination by clinical neurologists/geriatricians, including neuropsychiatric symptom evaluation with the Neuropsychiatric Inventory.
RESULTS: Factor analysis revealed five distinct neuropsychiatric syndromes: the apathetic syndrome (as unique syndrome) was the most frequent, followed by affective syndrome (anxiety and depression), psychomotor (agitation, irritability, and aberrant motor behavior), psychotic (delusions and hallucinations), and manic (disinhibition and euphoria) syndromes. More than three quarters of patients with AD presented with one or more of the syndromes (N = 790, 77.8%), and more than half exhibited clinically significant severity of symptoms (N = 603, 59.4%). With the exception of the affective one, all syndromes showed an increased occurrence with increasing severity of dementia.
CONCLUSIONS: The authors' study supports the use of a syndrome approach for neuropsychiatric evaluation in patients with AD. Individual neuropsychiatric symptoms can be reclassified into five distinct psychiatric syndromes. Clinicians should incorporate a thorough psychiatric and neurologic examination of patients with AD and consider therapeutic strategies that focus on psychiatric syndromes, rather than specific individual symptoms. 這篇文章歸納出五個癥候群 醫師應考慮針對神經精神上的癥候群的治療 而非個別性的病癥治療

Breast cancer bone metastasis:
Clin Calcium. 2011;21(3):429-438.
[Encounter of cancer cells with bone. Treatment of bone metastases from breast cancer.]
[Article in Japanese]
Taguchi T.
Department of Endocrine and Breast Surgery, Kyoto Prefectural University of Medicine.
Abstract
In metastatic breast cancer the most common metastatic site is bone. Skeletal-related events (SREs) as well as bone pain are well-known characteristics of bone metastasis. Activation of osteoclast is the most important mechanism for the progression of bone metastasis. To treat bone metastasis, not only administration of antitumor drug but also inhibition of osteoclast activity should be required. Bisphosphonates, as potent inhibitors of osteoclast function, reduce the morbidity of metastatic bone disease, decrease the prevalence of SREs, and improve control of bone pain. Molecular targeted agents which inhibit maturity and activity of osteoclast are under development, and some effectiveness has been proved in clinical trials. Long-term survival just like good control of a symptom is expected in future by using new drugs specific to bone metastasis as part of multidisciplinary approach.

J Clin Oncol. 2011 Feb 22. [Epub ahead of print]
American Society of Clinical Oncology Executive Summary of the Clinical Practice Guideline Update on the Role of Bone-Modifying Agents in Metastatic Breast Cancer.
Van Poznak CH, Temin S, Yee GC, Janjan NA, Barlow WE, Biermann JS, Bosserman LD, Geoghegan C, Hillner BE, Theriault RL, Zuckerman DS, Von Roenn JH.
University of Michigan, Ann Arbor, MI; American Society of Clinical Oncology, Alexandria; Virginia Commonwealth University, Richmond, VA; University of Nebraska Medical Center, Omaha, NE; Cancer Research and Biostatistics, Seattle, WA; Wilshire Oncology Medical Group, Rancho Cucamonga, CA; Y-ME National Breast Cancer Organization; Lurie Comp Cancer Center of Northwestern University, Chicago, IL; National Center for Policy Analysis, Dallas; The University of Texas MD Anderson Cancer Center, Houston, TX; and Mountain States Tumor Institute, Boise, ID.
Abstract
PURPOSE To update the recommendations on the role of bone-modifying agents in the prevention and treatment of skeletal-related events (SREs) for patients with metastatic breast cancer with bone metastases. METHODS A literature search using MEDLINE and the Cochrane Collaboration Library identified relevant studies published between January 2003 and November 2010. The primary outcomes of interest were SREs and time to SRE. Secondary outcomes included adverse events and pain. An Update Committee reviewed the literature and re-evaluated previous recommendations. Results Recommendations were modified to include a new agent. A recommendation regarding osteonecrosis of the jaw was added. Recommendations Bone-modifying agent therapy is only recommended for patients with breast cancer with evidence of bone metastases; denosumab 120 mg subcutaneously every 4 weeks, intravenous pamidronate 90 mg over no less than 2 hours, or zoledronic acid 4 mg over no less than 15 minutes every 3 to 4 weeks is recommended. There is insufficient evidence to demonstrate greater efficacy of one bone-modifying agent over another. In patients with a calculated serum creatinine clearance of more than 60 mg/min, no change in dosage, infusion time, or interval of bisphosphonate administration is required. Serum creatinine should be monitored before each dose. All patients should receive a dental examination and appropriate preventive dentistry before bone-modifying agent therapy and maintain optimal oral health. Current standards of care for cancer bone pain management should be applied at the onset of pain, in concert with the initiation of bone-modifying agent therapy. The use of biochemical markers to monitor bone-modifying agent use is not recommended.

[Karen Wheel]

Interesting info! Thanks for sharing! Karen