Translational Research
Volume 155, Issue 5 , Pages 247-255, May 2010

Markers of bone remodeling and skeletal morbidity in patients with solid tumors metastatic to the skeleton receiving the biphosphonate zoledronic acid

  • Giannis Mountzios

      Affiliations

    • Department of Medical Oncology, 251 General Airforce Hospital, University of Athens, Athens, Greece
    • Corresponding Author InformationReprint requests: Giannis Mountzios, PhD, Department of Medical Oncology, Univeristy Hospital Alexandra, 251 General Airforce Hospital, 3 P. Kanellopoulou Avenue, PC 115 25 Athens, Greece
  • ,
  • Evangelos Terpos

      Affiliations

    • Department of Biomedical Research, 251 General Airforce Hospital, University of Athens, Athens, Greece
  • ,
  • Konstantinos Syrigos

      Affiliations

    • “Sotiria” Hospital, 3rd Department of Biomedical Research, University of Athens, Athens, Greece
  • ,
  • Christos Papadimitriou

      Affiliations

    • Department of Clinical Therapeutics, “Alexandra” Hospital, University of Athens, Athens, Greece, University of Athens, Athens, Greece
  • ,
  • Giorgos Papadopoulos

      Affiliations

    • Department of Medical Oncology, 251 General Airforce Hospital, University of Athens, Athens, Greece
  • ,
  • Aristotelis Bamias

      Affiliations

    • Department of Clinical Therapeutics, “Alexandra” Hospital, University of Athens, Athens, Greece, University of Athens, Athens, Greece
  • ,
  • Myron Mavrikakis

      Affiliations

    • Department of Clinical Therapeutics, “Alexandra” Hospital, University of Athens, Athens, Greece, University of Athens, Athens, Greece
  • ,
  • Meletios-Athanassios Dimopoulos

      Affiliations

    • Department of Clinical Therapeutics, “Alexandra” Hospital, University of Athens, Athens, Greece, University of Athens, Athens, Greece

Received 18 September 2009; received in revised form 20 December 2009; accepted 9 January 2010. published online 08 February 2010.

The molecular triad, which includes the receptor activator of nuclear factor kappa-B ligand (RANKL), its receptor RANK, and the endogenous soluble RANKL decoy receptor osteoprotegerin (OPG), has emerged as an important determinant of bone metabolism. We aimed to evaluate the effect of treatment with the biphosphonate zoledronic acid (ZA) on biochemical markers of bone remodeling and to detect possible correlations of markerlevel changes with skeletal morbidity and clinical outcomes in patients with solid tumors and osseous metastases. The following serum markers were measured at the onset of skeletal metastases and after 6 months of treatment with ZA (4 mg intravenously monthly) in 70 patients with breast (n = 30), lung (n = 18), or prostate (n = 22) cancer: RANKL, OPG, C-terminal cross-linking telopeptide of type I collagen (CTX), tartrate-resistant acid phosphatase isoform 5b (TRACP-5b), bone-specific alkaline phosphatase (bALP), and osteopontin (OPN). Logistic regression models were applied to assess the correlation between marker-level changes and skeletal related events (SRE, primary endpoint), recurrence or progression, and death. Within a median follow-up of 32 months, 34 patients (48.6%) presented with at least 1 SRE and 48 patients (68.6%) relapsed. The RANKL/OPG ratio was upregulated in patients with breast and lung cancer, and it tended to decline after treatment with ZA, whereas prostate cancer patients presented with profound elevation of OPG only that persisted after treatment. CTX levels were significantly reduced after treatment in the whole study population (P = 0.003). None of the markers was able to predict skeletal morbidity or clinical outcomes independently of well-established prognostic clinical parameters.

Abbreviations: ECOG, eastern co-operative oncology group, OPN, osteopontin, NTX, N-telopeptide, collagen type I, CTX, C-telopeptide, collagen type I, TRACP-5b, 5b isoenzyme of tartrate-resistant acid phosphatase, bALP, alkaline phosphatase, bone isoenzyme, sRANKL, soluble receptor activator of nuclear factor kappa-B, NFκB, nuclear factor kappa-B, OPG, osteoprotegerin, LHRH, luteinizing hormone-releasing hormone, ELISA, enzyme-linked immunoSorbent assay 95%, CI, 95% confidence intervals, IQR, interquartile range, ANOVA, analysis of variance, PS, performance status, PSc, pain score, HR, hazard ratio, SRE, skeletal related events, NSCLC, non small-cell lung cancer

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 Supported by a Translational Research Fellowship (to G.M.) from the European Society of Medical Oncology (ESMO).

PII: S1931-5244(10)00009-5

doi:10.1016/j.trsl.2010.01.002

Translational Research
Volume 155, Issue 5 , Pages 247-255, May 2010