Newly diagnosed mets to spine

[jkdowl]

I just finished my 8th weekly taxol/herceptin treatment and my BS ordered a ct scan before my planned surgery. It showed multiple sclerotic areas in the thoracic and lumbar spine. I had a new bone scan and MRI on thursday and it confirmed mets to spine, it showed partial response to chemo. I am terrified! I had a bone scan on 12/10/10 prior to starting chemo on 12/28/10. I don't understand why this wasn't on the prior scan. Is the cancer spreading even on chemo? I am so scared... I have three young children and don't know how long I have to live.

[Sheila]

First, take a deep breath....you are certainly not alone here to get a scary report, or a report of bone mets....we always think the worse...guess that is normal after the cancer diagnosis. What did the bone scan in Dec show? Bone mets are treatable, as many on this board have had great success. I am guessing they may want to keep you on Herceptin indefinately...Where do you live, and can you possibly get another opinion? We are all here for you, please lean on us to ease your fears. Hoping you here from some others who have been down this road. By the way, I have twin girls who are going to be 36 this year...what a blessing they have been!

[Jackie07]

Hi,

As Sheila has stated, bone mets are treatable. Below are three abstracts on recent researches/reports:

Radiol Med. 2011 Feb 1. [Epub ahead of print]
High-intensity focused ultrasound (HIFU) in patients with solid malignancies: evaluation of feasibility, local tumour response and clinical results.
Orgera G, Monfardini L, Della Vigna P, Zhang L, Bonomo G, Arnone P, Padrenostro M, Orsi F.
Interventional Radiology Unit of European Institute of Oncology, 435 Via Ripamonti, 20141, Milan, Italy, gianluigi.orgera@ieo.it.
Abstract
PURPOSE: The purpose of this study was to evaluate the safety and efficacy of ultrasound-guided high-intensity focused ultrasound (USgHIFU) for ablation of solid tumours without damaging the surrounding structures.
MATERIALS AND METHODS: A specific written informed consent was obtained from every patient before treatment. From September 2008 to April 2009, 22 patients with 29 lesions were treated: nine patients with liver and/or soft-tissue metastases from colorectal carcinoma (CRC), six with pancreatic solid lesions, three with liver and/or bone metastases from breast cancer, one with osteosarcoma, one with muscle metastasis from lung cancer, one with iliac metastasis from multiple myeloma and one with abdominal liposarcoma. The mean diameter of tumours was 4.2 cm. All patients were evaluated 1 day, 1 month and 3 months after HIFU treatment by multidetector computed tomography (MDCT), positron-emission tomography (PET)-CT and clinical evaluation. The treatment time and adverse events were recorded.
RESULTS: All patients had one treatment. Average treatment and sonication times were, respectively, 162.7 and 37.4 min. PET-CT or/and MDCT showed complete response in 11/13 liver metastases; all bone, soft-tissue and pancreatic lesions were palliated in symptoms, with complete response to PET-CT, MDCT or magnetic resonance imaging (MRI); the liposarcoma was almost completely ablated at MRI. Local oedema was observed in three patients. No other side effects were observed. All patients were discharged 1-3 days after treatment.
CONCLUSIONS: According to our preliminary experience in a small number of patients, we conclude that HIFU ablation is a safe and feasible technique for locoregional treatment and is effective in pain control.


Oncologist. 2011 Jan 25. [Epub ahead of print]
Treatment Outcome and Prognostic Factors for Patients with Bone-Only Metastases of Breast Cancer: A Single-Institution Retrospective Analysis.
Niikura N, Liu J, Hayashi N, Palla SL, Tokuda Y, Hortobagyi GN, Ueno NT, Theriault RL.
Departments of Breast Medical Oncology and.
Abstract
Abstract Purpose. Limited information is available about the optimal management and clinical outcome of bone-only metastases in breast cancer patients. The objective of this study was to define prognostic factors for patients with bone-only metastases. Our second objective was to compare progression-free survival (PFS) and overall survival (OS) between patients with hormone receptor (HR)(+) tumors and bone-only metastases who received combinatory therapy (chemotherapy followed by endocrine therapy, or endocrine therapy combined with molecular targeted therapy) and those treated with endocrine or chemotherapy alone. Patients and Methods. We retrospectively identified 351 breast cancer patients diagnosed with bone-only metastasis in 1997-2008 at our institution. Results. Patients with metastasis detected at the time of their primary breast cancer diagnosis (rather than at recurrence), a single metastasis, or asymptomatic bone disease had a longer PFS interval, and patients with a performance status of 0-1, a single metastasis, or asymptomatic bone disease had a longer OS time. Among patients with HR(+) human epidermal growth factor receptor (HER)-2(-) disease, combinatory therapy was associated with longer PFS and OS times than with endocrine therapy. In multivariate analyses, combinatory therapy was not associated with longer PFS or OS times than with endocrine therapy. Among patients with HER-2(+) disease, trastuzumab led to a longer PFS interval but no difference in the OS time. Conclusion. Our results indicate that, for HR(+) disease, a prospective trial of chemotherapy followed by endocrine therapy is warranted to determine whether it prolongs survival more than endocrine therapy alone in patients with bone-only metastases.


Nat Rev Endocrinol. 2011 Jan 4. [Epub ahead of print]
Bone metastasis: mechanisms and therapeutic opportunities.
Suva LJ, Washam C, Nicholas RW, Griffin RJ.
Department of Orthopedic Surgery, Center for Orthopedic Research, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, AR 72205, USA.
Abstract
The skeleton is one of the most common sites for metastatic cancer, and tumors arising from the breast or prostate possess an increased propensity to spread to this site. The growth of disseminated tumor cells in the skeleton requires tumor cells to inhabit the bone marrow, from which they stimulate local bone cell activity. Crosstalk between tumor cells and resident bone and bone marrow cells disrupts normal bone homeostasis, which leads to tumor growth in bone. The metastatic tumor cells have the ability to elicit responses that stimulate bone resorption, bone formation or both. The net result of these activities is profound skeletal destruction that can have dire consequences for patients. The molecular mechanisms that underlie these painful and often incurable consequences of tumor metastasis to bone are beginning to be recognized, and they represent promising new molecular targets for therapy.

[DanaRT]

Dear jkdowl,

Keep the faith.

You will get terrific advice on this message board. Your young family sounds beautiful.

[Mary L]

Hi, so sorry that you have to go through this. I will be praying for you and sending you my best wishes. Mary L

[krisvell]

Dear jkdowl;
I am new to this journey as you are and please take a deep breath and try to stay calm. It's overwhelming to hear this news as it was for me a month ago today.There are a lot of wonderful HER2 sisters that gave me great information, encouragement and hope. It sounds like you are reacting to the scan results with no input from your Oncologist. That's a nerve-wracking time. It was getting the best of me and I started taking Adavan which has helped me during the 'wait' period.
There's a lot of treatment options and you will see there are lot of long time surviors on this site.
Sending hugs and prayers your way,
Kris....

[tricia keegan]

I'm sorry you've received this news but know there are many here who have been treated for bone mets sucessfully and can help and advise you.
I'm just guessing but not sure if the spots have to be a certain size before they show, so maybe thats why this was'nt picked up in Dec?
Sending good wishes to you, stay strong and I'll be thinking of you. xx

[Lani]

I recently posted the following on denosumab which was approved for bone mets from breast cancer shortly before this December's San Antonio Meeting and works at least as well if not better than bisphosphonates (zoladronic acid, etc)


newly approved drug may prove key in preventing metastasis

I had been advising people to keep their eyes out for the approval of denosumab, which was first approved for osteoporosis, and later for breast cancer bone mets.

Now there is evidence it may play a role in preventing mets in the first place

Key Culprit Identified In Breast Cancer Metastasis

Posted on: Wednesday, 16 February 2011, 17:09 CST

When doctors discover high concentrations of regulatory T cells in the tumors of breast cancer patients, the prognosis is often grim, though why exactly has long been unclear.

Now new research at the University of California, San Diego School of Medicine suggests these regulatory T cells, whose job is to help mediate the body's immune response, produce a protein that appears to hasten and intensify the spread of breast cancer to distant organs and, in doing so, dramatically increase the risk of death.

The findings are reported in the Feb. 16 advance online edition of the journal Nature.

The researchers found that mice with breast cancer were more likely to develop metastatic lung cancer due to elevated levels of RANKL, an inflammatory protein normally involved in bone remodeling. Regulatory T cells were found to be the primary source of RANKL in these tumors. However, the same increase in metastasis was seen when synthetic RANKL was injected directly into tumors, suggesting that RANKL was the key to the ability of regulatory T cells to promote the spread of breast cancer. The scientists also determined that interfering with the ability of RANKL to interact with cancer cells seemed to block tumor progression, and may represent a potential target for drug therapy.


"What is exciting about this study is that now that we understand an increase in RANKL translates to an increase in metastasis, we can get to work on figuring out ways to stop or slow the production of RANKL in breast cancer patients," said Michael Karin, PhD, Distinguished Professor of Pharmacology and Pathology at UCSD's Laboratory of Gene Regulation and Signal Transduction and Moores Cancer Center.

RANKL is a well-known factor in a variety of degenerative bone diseases, including rheumatoid arthritis and bone metastasis. In June 2010, the Food and Drug Administration approved the first RANKL-inhibiting drug for use in postmenopausal women at risk for osteoporosis.

"When we were able to control the RANKL production in the mice, we were able to slow or stop the spread of the cancer," Karin said. "The next logical step is to turn to drugs that block RANKL production to see how they might affect the spread of breast cancer."

Other breast cancer studies have linked RANKL to early stages in the development of synthetic progestin-driven breast tumors. According to the Women's Health Initiative and the Million Women Study, hormone replacement therapy and contraceptives with progestin significantly increase the risk of developing breast cancer. The findings from these studies and the new UCSD research suggest that drugs that block RANKL may be effective in preventing both the early stages of breast cancer and the advanced progression of the disease.

[Trish]

I had a clear bone scan in Dec 2006 but in April/May 2007 I had another bone scan that showed mets in multiple areas including spine, pelvis and ribs. I think they must have been there in a microscopic form in Dec 2006. In Jan 2007 I had two cracked ribs but the onc didn't re-do the bone scan at that time. I went to another oncologist who did the scan that found the mets. I commenced Zometa and the bone mets have not given me any trouble since then. Zometa has been really good for me so far and as Lani posted Denosumab is an option now for some people and hopefully for more of us soon. I am hopeful your mets can be successfully contained with treatment. Best wishes
Trish