State of Art and Advances on the Treatment of Bone Metastases From Breast Cancer

A Concise Review

Lorenzo Rossi; Claudio Longhitano; Florenc Kola; Maria Del Grande


Chin Clin Oncol. 2020;9(2):18 

In This Article

Abstract and Introduction


Bone is one of the most common metastatic sites in metastatic breast cancer (mBC). The presence of bone metastases can lead to various complications including pain, spinal cord compression, hypercalcaemia, pathological fractures. The treatment of bone metastases of breast cancer (BC) is mainly based on the biological characteristics of the primary tumour, but there are also specific treatments for bone lesions including bone modifiers, radionuclides, or localized treatments such as radiotherapy, surgery or vertebroplasty. In this review, we analyse the state of art of the common treatments and the advances of bone metastases of BC. Finally, we summarize the state of art of biomarkers in diagnosis, prognosis and prediction to therapy.


Incidence of breast cancer (BC) is growing every year.[1] Metastatic breast cancer (mBC) counts approximately 6–10% of new cases[2] ("de novo" metastatic disease), and it is estimated that 20% to 30% of all BC will develop metastases. Bone metastases (BM) count approximately 60–70% of all mBC[3,4] and more than 70% of patients showed bone metastases during autopsy.[5] Among the most important complications of BM there are pain, pathological fractures, spinal compression and hypercalcemia.

This complex of events is often included in the definition of skeletal-related events (SREs), in which the need for radiotherapy or surgery for pain or spinal cord decompression is also considered. In mBC, SREs occur in about half to two thirds of patients with bone metastases.[6] SREs remain a major cause of mortality and morbidity, and has an impact on the quality of life.[7] Furthermore, the occurrence of an SRE influences the median 5-year survival rate, reducing it from 8.3% to 2.5%.[6] Therefore, reducing the risk of SRE is a priority objective in these patients, and it is recommended to administrate bone-modifying agents (BMAs) before symptomatic events.[8–10] The purpose of this short review is to describe the state of the art of BM treatments, including systemic and loco-regional treatment of the bone. Finally, we will briefly discuss the current state of the art of promising biomarkers for the diagnosis and monitoring of BM.