bims-rebome 2026-05-31 papers

bims-rebome

Biomed News

on Management of bone metastases

Issue of 2026–05–31
seven papers selected by
Alberto Selvanetti, Azienda Ospedaliera San Giovanni Addolorata

The Use of Corticosteroid Treatment Protocols in Compressive Epidural Spinal Metastases: Current Practice and the Need for Consensus.
The Performance of Prognostic Measures for Survival in Spinal Metastatic Disease in Light of Modern Advancements in Medical and Surgical Management.
Management of bone metastases in patients with breast cancer: review of bone-modifying therapy, emerging new agents, and future directions.
Nanoparticle Strategies for Bone Metastasis Immunotherapy: Targeting, Immune Reprogramming and Combination Therapy.
Psychometric properties and clinical utility of the EORTC QLQ-BM22 in patients with bone metastases: a systematic review.
Follow-up care and support for patients with metastatic spinal cord compression: a service improvement initiative.
Decoding the Role of MDSCs in Bone Metastasis: Multicellular Interactions and Clinical Implications.

Spine (Phila Pa 1976). 2026 May 28.

The Use of Corticosteroid Treatment Protocols in Compressive Epidural Spinal Metastases: Current Practice and the Need for Consensus.

Kathleen S Botterbush, Mayur S Patel, Advika N Srinivas, Nathan D McLaughlin, Kaden L Wilson, Jorge F Urquiaga, Mauricio J Avila.

   STUDY DESIGN: Systematic review.
OBJECTIVE: To evaluate current protocols for corticosteroid use in patients with compressive epidural spinal metastasis.
SUMMARY OF BACKGROUND DATA: Spinal metastases are common in oncological patients. Although spinal cord compression is a less frequent manifestation, its occurrence represents a medical emergency. Despite over three decades of literature reporting recommendations for corticosteroid use in patients with metastatic spinal cord compression, there remains a lack of consensus regarding the optimal timing, dosage and duration of treatment.
METHODS: A systematic review was conducted in May 2025, including terms for epidural spinal metastasis and corticosteroids. 835 articles were screened for compressive metastatic epidural spinal lesions treated with systemic corticosteroids. Ultimately, 39 articles were included for final analysis, which included patient demographics, clinical characteristics, treatment modalities, adverse effects, and survival and ambulation outcomes. Studies were grouped into pre- and post-1997 based on NASCIS III, as well as evenly across three time periods.
RESULTS: Dexamethasone, hydrocortisone, methylprednisolone, and prednisone were used, with dexamethasone being the most common. The proportion of patients receiving steroid treatment and experiencing adverse effects were both significantly higher pre-1997 (P<0.0001). Survival outcomes were significantly higher post-1997 at all time frames. Pre-treatment ambulation was significantly higher post-1997 (P<0.0001). The proportion of patients ambulating pre-treatment was significantly higher with each subsequent period (42.11% vs. 62.72% vs. 70.59%; P<0.0001, P<0.0001, P<0.0001).
CONCLUSION: There remains a lack of consensus on literature for steroid use in compressive metastatic spine disease. Recent studies generally suggest 12-32 mg/day of dexamethasone. There are improvements in overall survival but not ambulation in patients with symptomatic metastatic spine disease, likely from improved overall oncological care but not necessarily treatment of the spinal metastases themselves. Development of clear guidelines for corticosteroid use in this population is imperative to optimize prognostic outcomes.

Keywords:  corticosteroids; dosing; drug regimen; epidural metastasis; malignancy; metastatic disease; metastatic spinal cord compression; spinal cord compression; spine; spine surgery

DOI:  https://doi.org/10.1097/BRS.0000000000005755
Spine (Phila Pa 1976). 2026 May 18.

The Performance of Prognostic Measures for Survival in Spinal Metastatic Disease in Light of Modern Advancements in Medical and Surgical Management.

Brendan M Striano, Marco L Ferrone, Kaitlyn E Holly, Christy Zheng, Andrew Nguyen, Joseph Macksood, Amelia Osgood, Joshua M Coan, J Prescott Chan, Patrick K Cronin, Daniel G Tobert, Andrew J Schoenfeld.

   STUDY DESIGN: Retrospective cohort.
OBJECTIVE: To compare the performance of four of the most widely used scoring systems for survival in spinal metastatic disease among a representative battery of cases treated in our health system during 2017-2022.
SUMMARY OF BACKGROUND DATA: None of the popular risk scores in use today effectively account for improved survival due to advancements in immunotherapy, molecular targeted treatment and surgical techniques.
METHODS: We assembled a representative battery of 997 patients who underwent operative or non-operative treatment for spinal metastases (2017-22). All patients were assigned a Tokuhashi, Tomita, Skeletal Oncology Research Group (SORG) and New England Spinal Metastasis Score (NESMS) based on data at initial presentation. The primary outcome was the discriminative capacity of the scoring utilities in predicting one-year mortality. This was evaluated using multivariable logistic regression with all variables included as co-variates. The discriminative capacity for each model was compared using the c-statistic. We also assessed the performance of operative management in conjunction with the survival score.
RESULTS: One year mortality was 54%. The SORG's c-statistic was 0.75 (95% CI 0.71, 0.78), compared to 0.68 (95% CI 0.65, 0.71) for the NESMS. The c-statistic for the Tokuhashi score was 0.70 (95% CI 0.67, 0.73), while that of the Tomita scale was 0.66 (95% CI 0.63, 0.69). Only the SORG (OR 0.64; 95% CI 0.46, 0.90; P=0.01) and NESMS (OR 0.74; 95% CI 0.56, 0.97; P=0.03) preserved a significant association between surgical intervention and survival.
CONCLUSIONS: We found that the performance of all scores were diminished relative to historical reports but remained adequate for the NESMS and SORG algorithm. In current practice, we believe the optimal approach entails initial use of the NESMS when considering treatment approach, with the SORG used for re-calculating survival if surgical intervention has been selected as a treatment strategy.
LEVEL OF EVIDENCE: III.

Keywords:  NESMS; SORG; immunotherapy; prognostic score; spinal metastases; surgery; survival

DOI:  https://doi.org/10.1097/BRS.0000000000005741
Front Oncol. 2026 ;16 1823973

Management of bone metastases in patients with breast cancer: review of bone-modifying therapy, emerging new agents, and future directions.

Gilbert Bader, Brianna Brown, Ashley Pariser Davenport, Margaret Gatti-Mays, Kai Cc Johnson, Nerea Lopetegui-Lia, Dionisa Quiroga, Arya Mariam Roy, Sagar Sardesai, Daniel Stover, Robert Wesolowski.

  Bone metastases occur in 65-75% of patients with metastatic breast cancer. They are often associated with skeletal-related events (SREs), leading to significant morbidity and decline in quality of life (QoL). Treatment with bone-modifying agents is crucial to decrease the risk of SREs and improve QoL. We used PubMed to review key clinical trials that studied the use of bisphosphonates (BPs) and denosumab for the treatment of osseous metastases in patients with metastatic breast cancer. We also reviewed agents that may have the potential to improve SREs. BPs - including clodronate, pamidronate, ibandronate, and zoledronic acid - as well as denosumab have shown efficacy and safety in the treatment of bone metastases secondary to breast cancer. Oral BPs are mainly used in Europe and other countries while zoledronic acid and denosumab are more commonly used in the United States. Zoledronic acid offers the convenience of a once-every-12-week dose. Denosumab may be superior. It is also associated with less renal toxicity and less acute-phase reactions. BPs and denosumab have shown good results; they are usually continued long-term as a palliative treatment. However, they are unlikely to revert osteolytic lesions. There is an unmet need for improvement of SREs. Bone-forming agents should be seriously considered for this purpose.

Keywords:  bisphosphonates; bone metastases; breast cancer; clodronate; denosumab; ibandronate; pamidronate; zoledronic acid

DOI:  https://doi.org/10.3389/fonc.2026.1823973
Pharmaceutics. 2026 May 04. pii: 571. [Epub ahead of print]18(5):

Nanoparticle Strategies for Bone Metastasis Immunotherapy: Targeting, Immune Reprogramming and Combination Therapy.

Mohamad Bakir, Abdul Rahman Alkhatib, Abdul Rehman Mustafa, Mohammed Raddaoui, Wael Alkattan, Khalid Said Mohammad.

  Bone metastases remain one of the most clinically devastating complications of advanced cancer, particularly in breast, prostate, and lung malignancies, where they drive pain, fractures, hypercalcemia, and progressive functional decline. Their management is further complicated by a highly immunosuppressive bone microenvironment characterized by osteoclast-driven bone destruction, myeloid cell dominance, impaired antigen presentation, and weak effector T-cell infiltration, all of which limit the activity of conventional immunotherapies. In this setting, nanoparticles are emerging not merely as passive drug carriers but as programmable platforms capable of reshaping the metastatic niche. This review discusses how bone-targeted and immune-responsive nanocarriers can improve therapeutic precision through hydroxyapatite-binding ligands, dual-targeting strategies, stealth coatings, enzyme- and pH-responsive release systems, and externally guided platforms. We further examine how these systems modulate key immune compartments within bone metastases, including reprogramming tumor-associated macrophages and myeloid-derived suppressor cells, restoring cytotoxic T-cell activity, enhancing dendritic-cell activation, and enabling in situ vaccination through photothermal or photodynamic immunogenic cell death. Particular attention is given to the delivery of checkpoint inhibitors, cytokines, siRNA/miRNA, mRNA, and clustered regularly interspaced short palindromic repeats (CRISPR)-based payloads, as well as to the rational combination of these with chemotherapy, bone-modifying agents, and radiotherapy. Finally, we highlight major translational barriers, including lesion heterogeneity, limited penetration into mineralized tissue, off-target immune effects, manufacturing complexity, and the continued lack of bone-specific preclinical and clinical validation. Collectively, immunomodulatory nanoparticles represent a promising strategy to convert bone metastases from immune-refractory sites into more therapeutically responsive lesions.

Keywords:  bone metastasis; bone-targeted drug delivery; cancer immunotherapy; nanoparticles; stimuli-responsive nanocarriers; tumor microenvironment

DOI:  https://doi.org/10.3390/pharmaceutics18050571
EClinicalMedicine. 2026 May;95 103970

Psychometric properties and clinical utility of the EORTC QLQ-BM22 in patients with bone metastases: a systematic review.

EORTC Quality of Life Groupu

   Background: The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire for bone metastases 22 (EORTC QLQ-BM22) is a site-specific health-related quality-of-life instrument for patients with bone metastases. However, modern treatments and extended survivorship have introduced new toxicity profiles and clinical challenges. We systematically assessed the measurement performance of QLQ-BM22 to determine if contemporary evidence supports updating the module.
Methods: A search was conducted using Medline, Embase, and Cochrane Central Register of Controlled Trials from inception to November 7, 2025. Two independent reviewers screened English-language articles reporting on the development, psychometric evaluation, or clinical application of the QLQ-BM22. Data regarding reliability, validity, responsiveness, and feasibility were extracted and synthesized. Studies using the module solely as an outcome measure without psychometric data were excluded. The review protocol was registered with PROSPERO (CRD420251052602).
Findings: 49 publications were included. While available in 32 language versions, clinical use was identified in at least 16. Internal consistency was generally high (Cronbach's α > 0·70), although variability was observed in the Painful Sites subscale (range α = 0·34-0·93). Test-retest reliability was excellent (intraclass correlation coefficient >0·90). Construct validity was supported by weak correlations (r < 0·40) with unrelated domains in the EORTC core questionnaire, confirming the module's divergent validity. Item-level missingness was generally low in completed questionnaires, although follow-up completion was more variable in longitudinal studies. Responsiveness was strongest in palliative radiotherapy settings, whereas evidence in surgical and systemic therapy settings remains limited.
Interpretation: While psychometrically sound, the reliance of QLQ-BM22 on historical validation data, limited cross-cultural validation, and inconsistent reliability in the Painful Sites subscale warrant an update. A modernized module is needed to capture contemporary symptom profiles, standardize cross-cultural measurement, and reduce burden.
Funding: This research was funded by the EORTC Quality of Life Group, grant number 005/2023.

Keywords:  Bone metastases; Cancer; Patient-reported outcomes; Psychometric properties; Quality of life; Questionnaires

DOI:  https://doi.org/10.1016/j.eclinm.2026.103970
Br J Nurs. 2026 May 21. 35(10): S12-S17

Follow-up care and support for patients with metastatic spinal cord compression: a service improvement initiative.

Emma Hall, Wendy Walker.

  Cancer care is high on the healthcare policy agenda in England. This article provides insight into a nurse-led service improvement initiative for people diagnosed with metastatic spinal cord compression (MSCC). The project methodology reflected a 'design thinking' approach to innovation, comprising the development and delivery of a solution to an identified problem/need. This involved the pilot testing of a multidisciplinary outpatient clinic and increased availability of educational MSCC resources in response to identified gaps in follow-up care and support. Key features of the clinic are presented, together with the results of an interim small-scale evaluation. The clinic was well attended, and positively evaluated by staff and patients alike. Staff capacity, particularly time to complete the clinic work schedules, was an identified challenge, with patient referral and attendance exceeding expectations. Evidence played an important role in gaining organisational support for service improvement and its ongoing development and sustainability in practice.

Keywords:  Cancer; Follow-up; Metastatic spinal cord compression; Patients; Service improvement; Support

DOI:  https://doi.org/10.12968/bjon.2025.0079
Pharmaceuticals (Basel). 2026 May 02. pii: 723. [Epub ahead of print]19(5):

Decoding the Role of MDSCs in Bone Metastasis: Multicellular Interactions and Clinical Implications.

Samaa Alotab, Mariam Zainab, Labibah Labib Khamies, Rasha Alissa, Khalid Said Mohammad.

  Bone metastasis remains a major cause of morbidity in advanced cancer, driven not only by tumor-bone crosstalk but also by profound immune remodeling within the marrow. Myeloid-derived suppressor cells (MDSCs), including polymorphonuclear (PMN-MDSC) and monocytic (M-MDSC) subsets, are increasingly recognized as central effectors of this process, integrating inflammatory signals with metabolic and stromal cues to enforce immune suppression and support skeletal colonization. In this review, we synthesize current evidence that bone metastases transform the bone marrow into an "MDSC amplifier," where vascular and endosteal niches, CXCL12-rich stromal compartments, hypoxia, and adipocyte-derived lipids collectively promote MDSC recruitment, persistence, and functional maturation. We discuss the dominant suppressive programs deployed by MDSCs in bone (e.g., arginase-1 activity, reactive oxygen/nitrogen species, and checkpoint ligand expression), and how these mechanisms converge to impair cytotoxic T-cell and NK-cell responses while fostering regulatory T-cell dominance. Importantly, because the marrow is a hematopoietic organ, bone lesions can also generate systemic consequences through myeloid spillover, providing a mechanistic basis for reduced responsiveness to immune checkpoint blockade in bone-dominant disease. We then evaluate pharmacologic strategies to target MDSCs in the context of bone metastasis, including approaches that block trafficking (e.g., CCR2/CXCR2 axes), deplete or reprogram suppressive myeloid states (e.g., STAT3-directed strategies, differentiation therapy), and disrupt bone-resorptive feedback loops (e.g., receptor activator of NF-κB ligand (RANKL) inhibition and bisphosphonates), emphasizing rational combinations and sequencing to limit marrow toxicity. Finally, we highlight emerging single-cell and spatial profiling tools that can resolve bone-specific heterogeneity in MDSCs and guide biomarker-driven, mechanism-informed therapeutic development.

Keywords:  bone metastasis; immunotherapy resistance; myeloid immunometabolism (hypoxia–lipid axis); myeloid-derived suppressor cells (MDSCs); osteoclastogenesis and bone remodeling; tumor immune microenvironment (TIME)

DOI:  https://doi.org/10.3390/ph19050723