Prevention of Metastasis?

I’m convinced that eradicating breast cancer won’t happen until we understand a lot more about breast cancer metastasis, the spread of cancer to other parts of the body.  People die from the metastases, not the primary tumors, and understanding how and why it happens, and how to prevent it, should be a research priority.

Commentary published online today in the Journal of Clinical Oncology makes some interesting points about breast cancer metastasis and raises some good questions.  Last year, researchers were surprised by findings in a study of bishphosphonates for bone loss in early breast cancer – the premenopausal women who took the bisphonsphonates had  not only less bone loss, but less bone metasases,  less loco-regional spread of the disease, and less spread to other parts of the body.

Dr. Philippe L. Bedard and Dr. Martine J. Piccart-Gebhart, in the article published today,  Sowing the Soil for Cure?  Results of the ABCSG-12 Trial Open a New Chapter in the Evolving Adjuvant Bisphosphonate Story in Early Breast Cancer,  ponder what the results mean and introduce several important questions.

Do breast cancer treatments that decrease bone density make the bone fertile ground for bone metastasis? Do bisphosphonates prevent this?

But why did the bisphosphonate drug appear to decrease the risk for loco-regional recurrence and spread to other areas besides bone?  Does the drug do more than just destroy the fertile ground for tumor growth? Does the bisphosphonate perhaps destroy tumor cells that were spread very early in disease, even before the growth of the primary tumor became apparent?

Very important questions indeed.  Let’s hope the surprise results from last year continue to stimulate discussion, questions, and most importantly research.

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  • Maria  On September 5, 2009 at 1:01 pm

    Laura, there was an article about macrophages and how they are somehow associated with the niches for those roving metastatic tumor cells. One study ablated the macrophages with clodronate (a bisphosphonate approved in Europe),and by doing so, made the niche unfavorable to the cells. So I got to wondering if THAT was why a bisphosphonate was possibly reducing visceral metastases.I just reread the Bedard article, however, and this affect on macrophages only happens with the non-nitrogen containing bisphosphonates, one of which is clodronate. Zoledronic acid contains nitrogen and acts in a different way.It’ll be fascinating research to follow.

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