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In advanced cancer patients, the most common site for the occurrence of metastasis is considered to be – the bone. Bone Metastasis occurs when cancerous cells from the primary tumor relocate to the bone. Although almost all cancers can spread to the bone, Bone Metastasis is most commonly observed in breast, prostate, and lung cancer patients. Bone Metastasis symptoms include bone pain, broken bones, urinary, and bowel incontinence, weakness in the legs or arms, and high levels of calcium in the blood (hypercalcemia), which can cause nausea, vomiting, constipation, and confusion.
Bone Metastasis diagnosis is based on signs, symptoms, and imaging; it has major clinical consequences for the patient concerned and, therefore, a timely and definite diagnosis is crucial. The standard of care imaging methods for Bone Metastasis detection includes plain X-ray, computed tomography (CT) scan, and radionuclide bone scintigraphy.
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Although Bone Metastasis treatment is rarely curative, disease control is often possible for many years by using systemic anticancer treatments on a background of multidisciplinary supportive care. This care includes bone-targeted agents such as bisphosphonates or denosumab to inhibit tumor-associated osteolysis and prevent skeletal morbidity and the use of appropriate local treatments such as radiation therapy, orthopedic surgery, and specialist palliative care to minimize the impact of metastatic bone disease on physical functioning. Bone Metastasis has an important impact on a patient’s quality of life so, new strategies are necessary to prevent skeletal disease and palliate established skeletal events. In addition, more studies are necessary to elucidate the interaction between the tumor cell and bone microenvironment to reach new therapeutic interventions.
According to DelveInsight’s analysis, the most prevalent cases of Bone Metastasis were observed to be breast cancer (121,603 cases) within the metastatic subset in the United States in 2020, followed by lung cancer, prostate cancer, and other solid tumors. Further analysis suggests that the number of cases of Bone Metastasis by tumor type is predicted to rise by 2030 owing to the launch of upcoming therapies, which is expected to create a positive shift in the Bone Metastasis market.
The development and progression of Bone Metastasis can be considered in several stages: colonization, quiescence, and progression, which can occur locally or regionally, leading to overt Bone Metastasis or dissemination to another location. The most prevalent symptom is pain. Bone Metastasis causes increased bone resorption, which increases the risk of several skeletal-related events (SREs) defined as pathological fracture, spinal cord compression, the need for bone irradiation or need for bone surgery, and hypercalcemia.
There are different types of Bone Metastasis observed due to constant change occurring in the bones. Cancerous cells obstruct the normal process of bone remodeling, causing the bones to become weaker or too dense, depending on the type of bone cells affected. Bone Metastasis can either be Osteoblastic, which is the case if there are too many new bone cells (this often happens with metastasized prostate cancer), or Osteolytic, if too much bone is destroyed (this often happens with metastasized breast cancer), whereas, in some Bone Metastasis cases, patients may experience both the types of metastasis, resulting in ‘mixed’ lesions.
Despite advancements in diagnostic technologies, the presence of bone metastases usually indicates an advanced disease stage with a median lifespan of only a few months and few potential treatments. The primary goals of clinical management for patients with bone metastases are to relieve pain, prevent bone complications, and maintain quality of life.
The life expectancy of cancer patients with Bone Metastasis has increased considerably due to considerable advancements in current therapies. Unfortunately, bone complications affect many of these patients, reducing their quality of life dramatically. Furthermore, with the present standard of care, patient adherence is sometimes hampered by the difficulty and length of administration. Apart from that, Bone Metastasis life expectancy usually lies somewhere between 6-48 months after the first metastatic bone cancer experienced.
The Bone Metastasis survival rate varies from patient to patient depending on the type of cancer and in which stage it is present currently. On top of that, the general health condition and type of Bone Metastasis treatment one has received are considered additional factors. Bone Metastasis survival rate is data gathered over a long period of time from a large number of people affected. According to a study which included 10 most common cancers with Bone Metastasis-
Some of the common cancers and their survival rates after Bone Metastasis are as follows:-
| Type of Cancer | The Percent of Cancer Cases That Metastasized After 5 Years | 5-year Survival Rate After Bone Metastasis |
| Prostate | 24.5 % | 6 % |
| Lung | 12.4 % | 1 % |
| Renal | 8.4 % | 5 % |
| Breast | 6 % | 13 % |
| GI | 3.2 % | 3 % |
The most common question related to Bone Metastasis is – how to treat Bone Metastasis Similar to DNA fingerprinting, Bone Metastasis treatment is exclusive to patients, highly individualized and requires a multidisciplinary approach. The treatment is different for different persons affected and it shall include the type of primary cancer observed, it’s current stage, which kind of bones are involved, prior cancer treatments taken and the overall health of a patient.
In general, the Bone Metastasis treatment include radiation therapies to slow the metastatic progression and reduce pain, chemotherapy to kill the cancerous cells and reduce the tumor size, hormone therapy to diminish the hormones that are involved with breast and prostate cancer, painkillers and steroids as pain relievers, drugs specifically targeting the Bone Metastasis, physical therapy helps in strengthening the muscles and increase mobility, extreme heat or cold targets cancer cells and may relieve pain, and lastly surgeries can be carried out if necessary to stabilize the bone, fix a break, and help with the pain.
In the United States, current Bone Metastasis treatment include marketed therapies like zoledronic acid and pamidronate disodium, both intravenous bisphosphonates, as well as Xgeva (denosumab), a RANK ligand inhibitor, which are approved as bone-targeting agents (BTA) and are used for the prevention of SREs in patients with Bone Metastasis. In addition, the US FDA approved Bayers’s Xofigo (radium [Ra]-223 dichloride) in May 2013 for the treatment of individuals with castration-resistant prostate cancer (CRPC), symptomatic Bone Metastasis, and no known visceral metastatic illness.
However, considering the overall benefits provided, Xgeva remains the current market leader. It is administered as a subcutaneous injection, has not been linked to renal toxicity or acute-phase reactions, and does not need to be dosed differently in patients with kidney impairment. Nonetheless, Xgeva’s market position is expected to be impacted by the entry of its biosimilars by 2025.
According to DelveInsight, the Bone Metastasis market size in the United States market was found to be USD 1,713.6 million in 2020.
Bone Metastasis emerging pipeline is currently very limited, with cabozantinib by Exelixis Inc. serving as the only late-phase asset. Cabozantinib is an oral small-molecule inhibitor of tyrosine kinases, involved in both normal cellular function and pathologic processes, such as tumor growth, metastasis, and angiogenesis. It is the origin of two commercial products, Cabometyx and Cometriq. Exelixis, its development partners, and other investigators are conducting several clinical trials on it. The drug is currently being evaluated in a Phase II clinical trial to study its efficacy in combination with fulvestrant in patients (18 years and older) with metastatic hormone-receptor-positive breast cancer that has spread to the bone. It is predicted to emerge as a new market leader after demonstrating efficacy in several trials across various solid tumors and by demonstrating progression-free and survival improvements when combined with standard anticancer therapy.
9-ING-41 is another asset in the development. Actuate Therapeutics is developing it as a first-in-class, intravenously administered, maleimide-based small molecule potent selective Glycogen Synthase Kinase-3 Beta (GSK-3) inhibitor, which has shown to have substantial preclinical anticancer efficacy.
According to an estimate by DelveInsight, the market size of cabozantinib is expected to reach USD 2,160.2 million by 2030, thus making it a new Bone Metastasis market leader. Also, the market size of Xofigo, which was only approved for prostate cancer patients with Bone Metastasis, was found to be USD 156.8 million in 2020.
A rise in the incidence of Bone Metastasis cases serves as a dire need for new Bone Metastasis treatment therapies in the market. Increasing prevalence offers opportunities to companies to launch new therapies in the market. Novel explorative therapies including the development of promising circulating and tissue biomarkers for the treatment of Bone Metastasis shall increase the Bone Metastasis market potential.
Although there are few diagnostic challenges experienced during the assessment of Bone Metastasis that include lack of an effective multidisciplinary approach to treatment, not reported or diagnosed cases, and lack of a robust pipeline, DelveInsight estimates suggest that new entry of key pharmaceuticals associated with the novel effective therapies, R&D, and the discovery of novel biomarkers for diagnosis, shall propel the Bone Metastasis market landscape and treatment scenario.
The growing incidence of cancer and increased awareness regarding metastatic bone cancer observed throughout the world, is indicative of the tremendous impact that Bone Metastasis is supposed to have on an affected cancer patients’ quality of life, the complete Bone Metastasis treatment landscape is expected to change significantly in the coming years.
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Dec 10, 2024
