臨床整形外科58巻12号

2023年12月発行

特集 がん時代の整形外科必携！　骨転移診療アップデート 骨転移集学的治療各論

整形外科医が骨修飾薬を活用するために知っておきたいこと

著者： 原仁美¹

所属機関： ¹神戸大学大学院医学系研究科整形外科学分野

ページ範囲：P.1481 - P.1486

骨修飾薬(BMA)はがんの骨転移による骨関連事象(SRE)を抑制する効果がある．日本では，主にゾレドロン酸とデノスマブが使用されており，近年はデノスマブの使用割合が高い．骨転移患者数の多いがん種に対するBMAの有効性，BMAの有害事象，BMAの投与間隔の延長と投与期間についてまとめた．今後は未解決事項が明らかにされ，がん治療の変化に応じてBMAの使い方も進化していく可能性がある．

参考文献

1）国立がんセンター，日本整形外科学会骨・軟部腫瘍委員会(編)．全国骨腫瘍登録一覧表　令和3年度．

2）Conen K, Hagmann R, Hess V, et al. Incidence and predictors of Bone Metastases (BM) and Skeletal-Related Events (SREs) in Small Cell Lung Cancer (SCLC):a Swiss patient cohort. J Cancer 2016;7(14):2110-6.

3）Rosen LS, Gordon D, Tchekmedyian S, et al. Zoledronic acid versus placebo in the treatment of skeletal metastases in patients with lung cancer and other solid tumors:a phase III, double-blind, randomized trial--the Zoledronic Acid Lung Cancer and Other Solid Tumors Study Group. J Clin Oncol 2003;21(16):3150-7.

4）Henry DH, Costa L, Goldwasser F, et al. Randomized, double-blind study of denosumab versus zoledronic acid in the treatment of bone metastases in patients with advanced cancer (excluding breast and prostate cancer) or multiple myeloma. J Clin Oncol 2011;29(9):1125-32.

5）Vadhan-Raj S, von Moos R, Fallowfield LJ, et al. Clinical benefit in patients with metastatic bone disease:results of a phase 3 study of denosumab versus zoledronic acid. Ann Oncol 2012;23(12):3045-51.

6）Lipton A, Theriault RL, Hortobagyi GN, et al. Pamidronate prevents skeletal complications and is effective palliative treatment in women with breast carcinoma and osteolytic bone metastases:long term follow-up of two randomized, placebo-controlled trials. Cancer 2000;88(5):1082-90.

7）Rosen LS, Gordon DH, Dugan W Jr, et al. Zoledronic acid is superior to pamidronate for the treatment of bone metastases in breast carcinoma patients with at least one osteolytic lesion. Cancer 2004;100(1):36-43.

8）Kohno N, Aogi K, Minami H, et al. Zoledronic acid significantly reduces skeletal complications compared with placebo in Japanese women with bone metastases from breast cancer:a randomized, placebo-controlled trial. J Clin Oncol 2005;23(15):3314-21.

9）Stopeck AT, Lipton A, Body JJ, et al. Denosumab compared with zoledronic acid for the treatment of bone metastases in patients with advanced breast cancer:a randomized, double-blind study. J Clin Oncol 2010;28(35):5132-9.

10）Smith MR, Halabi S, Ryan CJ, et al. Randomized controlled trial of early zoledronic acid in men with castration-sensitive prostate cancer and bone metastases:results of CALGB 90202 (alliance). J Clin Oncol 2014;32(11):1143-50.

11）Fizazi K, Carducci M, Smith M, et al. Denosumab versus zoledronic acid for treatment of bone metastases in men with castration-resistant prostate cancer:a randomised, double-blind study. Lancet 2011;377(9768):813-22.

12）Smith MR, Coleman RE, Klotz L, et al. Denosumab for the prevention of skeletal complications in metastatic castration-resistant prostate cancer:comparison of skeletal-related events and symptomatic skeletal events. Ann Oncol 2015;26(2):368-74.

13）岸本裕充，萩野　浩，北川善政・他；顎骨壊死検討委員会．薬剤関連顎骨壊死の病態と管理：顎骨壊死検討委員会ポジションペーパー2023．　https://www.jsoms.or.jp/medical/pdf/work/guideline_202307.pdf(2023年8月24日アクセス)

14）Shane E, Burr D, Abrahamsen B, et al. Atypical subtrochanteric and diaphyseal femoral fractures:second report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res 2014;29(1):1-23.

15）Menshawy A, Mattar O, Abdulkarim A, et al. Denosumab versus bisphosphonates in patients with advanced cancers-related bone metastasis:systematic review and meta-analysis of randomized controlled trials. Support Care Cancer 2018;26(4):1029-38.

16）Lipton A, Fizazi K, Stopeck AT, et al. Superiority of denosumab to zoledronic acid for prevention of skeletal-related events:a combined analysis of 3 pivotal, randomised, phase 3 trials. Eur J Cancer 2012;48(16):3082-92.

17）Santini D, Galvano A, Pantano F, et al. How do skeletal morbidity rate and special toxicities affect 12-week versus 4-week schedule zoledronic acid efficacy? A systematic review and a meta-analysis of randomized trials. Crit Rev Oncol Hematol 2019;142:68-75.