Systemic therapy options in malignant bone diseases

Bone metastases (secondary bone neoplasms) represent a more significant epidemiological problem than primary bone neoplasms. The differing histogenesis of primary and secondary malignant bone neoplasms (respectively, mesenchymal and epithelial origin) influences the variability of activity and indications for systemic therapy. A common response is the use of systemic therapy within a multidisciplinary therapeutic approach. The principles of chemotherapy used for primary bone neoplasms are essentially similar in spindle-cell and small-cell sarcomas. Initial multi-drug chemotherapy should be administered in all stages. Chemotherapy may also be used following local treatment, although the role of adjuvant chemotherapy is better defined in small-cell sarcomas. Chemotherapy is also applied in the palliative management of disseminated sarcomas. Systemic therapy plays an essential role in the management of patients with bone metastases during the course of breast and prostate carcinoma. The use of hormonal therapy is based on endocrine dependency of both malignancies. Chemotherapy represents a treatment of choice in several clinical situations due to high chemosensitivity of the underlying malignancy (e. g., small-cell lung cancer or lymphoma). Bisphosphonates play an important role in the management of bone metastases. The use of bisphosphonates is most justified in patients with breast cancer, multiple myeloma, and prostate carcinoma.