| Release date: January 2009 Expiration date: January 31, 2010 Estimated time to complete activity: 2.0 hours |
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Activity Overview
Bone metastasis is a common feature of advanced-stage cancer. Despite a decline in cancer-related death in general over the past decade, the development of bone metastasis is still associated with a marked reduction in 5-year survival rates and significant disease-related morbidity. Patients with bone metastases often experience a reduced quality of life from severe pain and an increased incidence of skeletal-related events, including pathologic fractures, spinal cord compression, and hypercalcemia. Recent advances in the understanding of the complex interaction of cancer cells with their microenvironment, as well as the pathophysiology surrounding bone metastases, are driving the development of novel therapeutic options for these patients. Current treatments are aimed at lessening the impact of existing bone metastases. Novel therapies directed towards cancer cell signaling mechanisms and the tumor microenvironment itself are being developed and may decrease the development of metastatic disease, as well as provide additional therapeutic options to manage ongoing bone loss resulting from commonly employed oncologic therapies. This activity provides the latest clinical advances in the management of cancer-related bone complications and reviews the current knowledge of the pathophysiology involved in these complications. A discussion of new and emerging therapies is also featured.
Target Audience
This activity has been designed to meet the educational needs of medical oncologists, urologic oncologists, urologists, radiation oncologists, hematologist-oncologists, and other health care providers who manage patients with cancer that has metastasized or has the propensity to metastasize to bone.
Learning Objectives
Upon completion of this activity, participants should be able to:
- Recognize the clinical impact of bone metastases with respect to skeletal-related events
- Describe the pathophysiology of bone metastasis
- Describe the current standard for treatment and prevention of skeletal-related events in patients with cancer that has metastasized to bone
- Assess the risks and benefits associated with current therapies for bone metastasis
- Evaluate the clinical data on the appropriate use of novel agents in development for the prevention and treatment of bone metastases as well as the prevention and treatment of bone loss secondary to oncologic therapies
- Compare and contrast the mechanisms of actions of bisphosphonates and novel bone-targeting agents
Allan Lipton, MD—Activity Chair View bio
Professor of Medicine & Oncology
Milton S. Hershey Medical Center
Hershey, Pennsylvania
Gordon A. Brown, DO View bio
Assistant Clinical Professor of Urology
UMDNJ University Hospitals
Department of Surgery
Division of Urology
University of Medicine and Dentistry of New Jersey
Stratford, New Jersey
Gregory R. Mundy, MD View bio
Professor of Medicine, Pharmacology, Orthopedics, Cancer Biology
Vanderbilt University Medical Center
John A. Oates Chair in Translational Medicine
Director, Vanderbilt Center for Bone Biology
Nashville, Tennessee
G. David Roodman, MD, PhD View bio
Professor of Medicine
University of Pittsburgh School of Medicine
Director, Bone Biology Center
University of Pittsburgh Medical Center
Pittsburgh, Pennsylvania
Matthew R. Smith, MD, PhD View bio
Director, Genitourinary Medical Oncology
Massachusetts General Hospital
Associate Professor of Medicine
Harvard Medical School
Boston, Massachusetts
Disclosure
In accordance with the Accreditation Council for Continuing Medical Education’s (ACCME) Standards for Commercial Support, all CME providers are required to disclose to the activity audience the relevant financial relationships of everyone in a position to control content of an educational activity. A relevant financial relationship is a relationship in any amount occurring in the last 12 months with a commercial interest whose products or services are discussed in the CME activity content over which the individual has control. Relationship information appears below:
Gordon A. Brown, DO, has disclosed the following relevant financial relationship:
| Advisory Board, Lecturer | Aureon |
| Speaker | Sanofi-AventisB |
Allan Lipton, MD, has disclosed the following relevant financial relationship:
| Consultant | Acceleron Pharma, GTx, Merck, Monogram Biosciences |
| Expert Testimony | Novartis |
| Speaker | Amgen, Novartis |
| Research Support | Monogram Biosciences, Novartis |
Gregory R. Mundy, MD, has disclosed the following relevant financial relationship:
| Consultant | Roche Diagnostics |
G. David Roodman, MD, has disclosed the following relevant financial relationship:
| Consultant | Acceleron Pharma, Amgen, Celgene, Novartis |
| Speaker/Research Support | Novartis |
Matthew R. Smith, MD, PhD, has disclosed the following relevant financial relationship:
| Consultant | Amgen, GTx, Merck, Novartis |
| Research Support | Amgen, Novartis |
Curatio CME Institute
Matthew D. Horn, MD, Medical Director, has disclosed no relevant financial relationships.
Denise C. LaTemple, PhD, Vice President, Scientific Services, has disclosed no relevant financial relationships.
Jonathan S. Simmons, ELS, Managing Editor, has disclosed no relevant financial relationships.
Derek Warnick, CME Director, has disclosed no relevant financial relationships.
Accreditation Statement
Curatio CME Institute is accredited by the ACCME to provide continuing medical education for physicians.
Credit Designation
Curatio CME Institute designates this educational activity for a maximum of 2.0 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Method of Participation
There are no fees for participating in this CME activity. To receive credit during the period January 2009 to January 31, 2010, participants must (1) read the learning objectives and disclosure statements, (2) study all sections of the educational activity, (3) complete the posttest, and (4) complete the activity evaluation form, including the certificate information section.
To obtain a certificate, participants must receive a score of 70% or better on the posttest. The posttest can be accessed at the end of the activity. Please e-mail any questions to cmeinfo@curatiocme.com.
Medium
The Internet was selected as the instructional format to accommodate the learning preferences of a significant portion of the target audience.
Disclaimer
The information presented at this activity is for continuing medical education purposes only and is not meant to substitute for the independent medical judgment of a physician regarding diagnosis and treatment of a specific patient’s medical condition.
Unapproved Product Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the US Food and Drug Administration. Curatio CME Institute and Amgen do not recommend the use of any agent outside the labeled indications.
The opinions expressed in this educational activity are those of the faculty and do not necessarily represent the views of Curatio CME Institute and Amgen. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
| Generic Name | Trade Name | Approved Use (if any) | Unapproved/ Investigational Use |
| Alendronate | Fosamax® | Treatment and prevention of osteoporosis in women; treatment of osteoporosis in men; treatment of glucocorticoid–induced osteoporosis in men and women; Paget’s disease in men and women | Treatment and prevention of bone metastasis; treatment and prevention of cancer therapy–induced bone loss |
| Anti-DKK1 | N/A | Investigational agent–novel DKK1 inhibitor/Wnt pathway stimulant | Direct antineoplastic effect on myeloma cells; treatment and prevention of bone metastasis |
| Atrasentan | Xinlay™ | Investigational agent–novel endothelin–A antagonist | Treatment and prevention of bone metastasis; antiresorptive agent |
| AZD0530 | N/A | Investigational agent–novel Src/Abl kinase inhibitor | Treatment and prevention of bone metastasis |
| Balicatib (AAE-581) | N/A | Investigational agent–novel cathepsin K inhibitor | Treatment and prevention of bone metastasis; antiresorptive agent |
| Bortezomib | Velcade® | Treatment of multiple myeloma in patients who have not responded to at least one other agent | Treatment and prevention of bone metastasis |
| Clodronate | Bonefos® | Treatment of hypercalcemia of malignancy (outside the United States; not approved by the U.S. FDA) | Treatment and prevention of bone metastasis |
| Denosumab | N/A | Investigational agent–novel RANKL antibody | Treatment and prevention of bone metastasis; treatment and prevention of cancer therapy–induced bone loss |
| Etidronate | Didronel® | Indicated for Paget's disease; prevention of heterotropic ossification following hip replacement or spinal cord surgery | Prevention and treatment of bone metastasis |
| Ibandronate | Boniva® | Treatment and prevention of osteoporosis in postmenopausal women | Treatment and prevention of bone metastasis |
| Ki26894 | N/A | Investigational agent–novel TGFβ kinase inhibitor | Treatment and prevention of bone metastasis; antiresorptive agent |
| Lenalidomide | Revlimid® | Treatment of multiple myeloma in combination with dexamethasone in patients for whom at least one other therapy has failed; transfusion-dependent anemia due to myelodysplastic syndromes associated with a deletion 5q | Treatment and prevention of bone metastasis |
| L-000845704 | N/A | Investigational agent–novel integrin inhibitor | Treatment and prevention of bone metastasis; antiresorptive agent |
| Odanacatib (MK-0822) | N/A | Investigational agent–novel cathepsin K inhibitor | Treatment and prevention of bone metastasis; antiresorptive agent |
| Pamidronate | Aredia® | Treatment of Paget’s disease, hypercalcemia of malignancy, and the osteolytic bone metastases of multiple myeloma and breast cancer | Prevention of bone metastasis; treatment of bone metastasis in prostate cancer; prevention and treatment of cancer therapy-induced bone loss |
| Raloxifene | Evista® | Treatment and prevention of osteoporosis in women; reduction in risk of breast cancer in postmenopausal women with osteoporosis or at increased risk for invasive breast cancer | Treatment and prevention of cancer therapy–induced bone loss in prostate cancer patients receiving GnRH agonist therapy |
| Relacatib (SB-462795) | N/A | Investigational agent–novel cathepsin K inhibitor | Treatment and prevention of bone metastasis; antiresorptive agent |
| Risedronate | Actonel® | Treatment and prevention of postmenopausal osteoporosis; treatment to increase bone mass in men with osteoporosis; glucocorticoid-induced osteoporosis; Paget’s disease | Treatment and prevention of cancer therapy–induced bone loss |
| SC56631 | N/A | Investigational agent–novel integrin inhibitor | Treatment and prevention of bone metastasis; antiresorptive agent |
| Toremifene | Fareston® | Treatment of metastatic breast cancer in postmenopausal women with estrogen receptor–positive tumors | Treatment and prevention of cancer therapy–induced bone loss in prostate cancer patients receiving GnRH agonist therapy |
| Zoledronic acid | Zometa® | Treatment of hypercalcemia of malignancy; multiple myeloma; solid tumors with documented metastasis to bone (in conjunction with standard antineoplastic therapy); prostate cancer that has progressed after hormonal therapy | Prevention of bone metastases; direct antineoplastic effect when used in combination with standard antineoplastic therapies; treatment and prevention of cancer therapy–induced bone loss |
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