Transcript

One of the important points about patients with advanced lung cancer is that 30-40% of patients will develop bone metastases. I think it’s important to recognize this is not bone cancer, this is lung cancer that’s moved to the bone, and in 30-40% of patients at some point who have advanced stage lung cancer, they will develop bone metastases. The question is: how do you manage these patients?

Dr. Gerard Silvestri, Medical University of South Carolina, describes some of the typical presenting symptoms of lung cancer.

Please feel free to offer comments and raise questions in our Discussion Forums.

Transcript

Late last year, I reviewed the approval of the agent XGEVA (denosumab) for patients with skeletal metastases from solid tumors after a randomized phase III trial demonstrated a significant reduction in the rate of development of skeletal-related events compared with the pre-existing standard of Zometa (zoledronic acid) for bone metastases.

When is surgery necessary or just particularly helpful for bone metastases? There are situations in which invasive approaches may be appropriate for the long bones (of the arms and legs). First, surgery can be helpful for persistent or increasing pain despite completing palliative radiation therapy.

We've established that bone metastases are common, and now we'll talk about approaches to manage pain that often accompanies them. As I mentioned previously, sometimes a metastases occurs in a weight-bearing bone, in which case we often recommend a prophylactic surgical procedure to stabilize the bone at risk for fracture. Radiation can also reduce the risk for fracture and improve pain.

I've discussed the general management of metastatic lung cancer, both SCLC and NSCLC, but there are also several common complications that sometimes require particular management. Bone metastases, for instance, may be treated by the same "whole body" approach with chemotherapy that treats other areas of tumor involvement, but may also benefit from additional approaches.