1,720,978 research outputs found
Perspectives in the elderly patients: benefits and limits of bisphosphonates and denosumab
No full textSkeletal metastases affect a large percentage of the cancer population and
contribute to a marked decrease in their quality of life and survival, in
particular in elderly population. A future end-point of bone-protecting therapy
is the demonstration of its ability to prevent or improve results in the
treatment of metastatic disease, enlarging their clinical indications in
metastatic and osteoporotic setting with different schedules. In this chapter we
will discuss on pharmacokinetic and pharmacodynamic interactions of
bisphosphonates in elderly, and the preclinical and clinical evidences of
anticancer activity of bone-targeted therapies will be critically described. The
clinical results of new targeted therapies (such as rank/rankl/OPG inhibition)
will be reported both in bone metastatic and in adjuvant settings. Finally, the
prevention of cancer treatment-induced bone loss (CTIBL) represents both in young
and more in old patients an emerging issue in the bone health care. For this
reason, this chapter will discuss the results of current therapies in this
clinical setting
Chemotherapy in biliary tract cancer
No full textBackground: Biliary Tract Cancer is a rare and aggressive tumor characterized by unresponsiveness to chemotherapy and radiotherapy in the vast majority of cases. Surgery offers the only possibility of a cure, though post-operative disease recurrence is common. Only few randomized trials with few patients have been conducted to in this setting of patients and standard chemotherapy has not been established yet. Results and Conclusions: This article summarizes the most important clinical trials regarding chemotherapy for biliary tract cancer and the first evidences regarding the adjuvant treatment. Moreover the clinical trials evaluating targeted therapy will be described, especially those assessing the role of anti-EGFR and antiangiogenic agents
Zoledronic acid in the management of metastatic bone disease
No full textBisphosphonate therapy has become a standard of therapy for patients with malignant bone disease. Moreover, in vivo preclinical and preliminary clinical data suggest that bisphosphonates may prevent cancer treatment-induced bone loss and the onset of malignant bone disease in patients with early-stage cancer. This comprehensive review critically reports the several preclinical evidences of action of bisphosphonates on osteoclasts, lymphocytes and tumour cells. In addition, all the clinical trials evaluating the effects of principal bisphosphonates on skeletal disease progression in patients with breast cancer, prostate cancer, non-small cell lung cancer and other cancers have been reported. Of the available bisphosphonates, intravenous zoledronic acid has demonstrated the broadest clinical activity and is actually approved for the treatment of bone metastases from any solid tumour in many countries. Renal safety is an important consideration for oncologists who are treating patients with bisphosphonates. This issue and the other topics relating to the safety of bisphosphonates are discussed in this review
Are bisphosphonates the suitable anticancer drugs for the elderly?
No full textBone metastases represent an important problem in the elderly. These patients are exposed to a higher risk of developing skeletal-related events (SREs) with a subsequent decrease in quality of life and survival. Bisphosphonates have demonstrated to reduce and delay the appearance of SREs and to improve the quality of life also in elderly bone metastatic patients. Moreover. in vitro and in vivo preclinical studies suggest that bisphosphonates exert direct as well as indirect antitumor effect. Interestingly, recent clinical data confirm these results in bone metastatic cancer patients. However, randomized trials restricted to elderly patients with metastatic bone disease and focused to evaluate survival benefits have not yet been planned even if elderly patients. especially multiple myeloma. prostate and lung cancer patients, have been often included in trials. This review will examine in detail the preclinical rationale for using bisphosphonates as anticancer agents in elderly patients and will critically explore the first retrospective and prospective clinical evidences, of an increased Survival in patients treated with bisphosphonates. Moreover, we will analyze the safety of bisphosphonates in elderly Population and discuss the clinical recommendations expressed by the SIOG Society for the use of bisphosphonates in elderly patients. Randomized clinical trials to assess the role of bisphosphonate therapy in the adjuvant setting are currently in progress and will be described in this review. If the results of these ongoing clinical trials will be positive, the indications for bisphosphonates could increase, including also elderly patients. (c) 2008 Elsevier Ireland Ltd. All rights reserved
Targeted therapy in biliary tract cancer: 2009 update
No full textBiliary tract cancers (BTCs) include cholangiocarcinoma (intrahepatic, perihilar and extrahepatic), carcinoma of the gall bladder and ampullary carcinoma. In patients with advanced disease the prognosis is poor, There is not a consensus regarding treatment strategy. Chemotherapy has only limited efficacy, This review summarizes the new approaches for BTC patients and the rationale for targeted therapies. The prognostic factors and the molecular features of BTC are analyzed. The clinical trials evaluating the targeted agents are accurately described, especially those assessing the role of anti-EGFR and antiangiogenic drugs. The ongoing trials are also analyzed. In fact, only the results of these trials will establish which is the most effective agent or combination for this setting
Hormono-biological therapy in metastatic breast cancer: preclinical evidence, clinical studies and future directions
No full textBreast cancer growth is regulated by coordinated actions of the estrogen receptor (ER) and various growth factor receptor signalling pathways. This complex interactive signalling potentially explains some of the reasons behind endocrine therapy action and resistance. Recent research into the molecular biology of ER signalling has revealed new molecular targets which, if present in cancer cells, might be additionally targeted using various signal transduction inhibitors to overcome or prevent resistance to endocrine therapy. The dynamic inverse relationship between the expression of ER and growth factor receptors brings more excitement to the potential of restoring ER expression in apparently ER-negative cells by inhibition of growth factor signalling. The multiple pathways involved in activating ERs also provide a rationale for combining endocrine and non-endocrine therapies that block different signalling pathways. Ongoing clinical trials promise to further improve the present care for breast cancer patients
Bisphosphonates effects in cancer and inflammatory diseases:in vitro and in vivo modulation of cytokine activities
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