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Advancing Treatment for Metastatic Bone Cancer: Consensus Recommendations from the Second Cambridge Conference

Authors' Affiliations: ¹ The University of Sheffield Cancer Research Centre,Weston Park Hospital, Academic Unit of Clinical Oncology and ² University of Sheffield Metabolic Bone Centre, Sheffield, United Kingdom; ³ University of Virginia, Department of Internal Medicine, Division of Endocrinology, Charlottesville, Virginia; ⁴ Penn State University, College Of Medicine, Milton S. Hershey Medical Center, Department of Medicine & Oncology, Hershey, Pennsylvania; ⁵ Veterans Administration Pittsburgh Healthcare System, Department of Medicine, Pittsburgh, Pennsylvania; ⁶ The Institute for Myeloma & Bone Cancer Research, West Hollywood, California; ⁷ CHU Brugmann,Universite Libre de Bruxelles, Brussels, Belgium; ⁸ University of Rochester School of Medicine & Dentistry, Division of Endocrine Metabolism, Rochester, New York; ⁹ University Hospital of Giessen and Marburg GmbH, Department of Endocrinology, Marburg, Germany; ¹⁰ Centre Hospitalier de l'Universite de Montreal, Hopital Notre-Dame, Department of Urologic Oncology, Montreal, Quebec Canada, ¹¹ Massachusetts General Hospital Cancer Center, Department of Genitourinary Medical Oncology, Boston, Massachusetts; ¹² University of Arkansas for Medical Sciences, Center for Orthopaedic Research, Little Rock, Arkansas; ¹³ University of Michigan School of Dentistry, Department of Periodontics and Oral Medicine, Ann Arbor, Michigan; ¹⁴ University of Washington, Genitourinary Cancer Research, Seattle, Washington; and ¹⁵ Washington University School of Medicine, Division of Molecular Oncology, St Louis, Missouri, United States

Requests for reprints: Robert E. Coleman, University of Sheffield Cancer Research Center, Weston Park Hospital, Academic Unit of Clinical Oncology, Whitham Road, Sheffield, S102SJ, UK. Phone: 44-114-226-5213; Fax: 11-44-114-226-5678; E-mail: r.e.coleman{at}sheffield.ac.uk.

Purpose: Summarize current knowledge, critical gaps in knowledge, and recommendations to advance the field of metastatic bone cancer.

Experimental Design: A multidisciplinary consensus conference was convened to review recent progress in basic and clinical research, assess critical gaps in current knowledge, and prioritize recommendations to advance research in the next 5 years. The program addressed three principal topics: biology of metastasis, preserving normal bone health, and optimizing bone-targeted therapies.

Results: A variety of specific recommendations were identified as important to advance research and clinical care over the next 5 years.

Conclusions: Priorities for research in bone biology include characterizing components of the stem cell niche in bone, developing oncogenic immunocompetent animal models of bone metastasis, and investigating the unique contribution of the bone microenvironment to tumor growth and dormancy. Priorities for research in preserving normal bone health include developing methods to measure and characterize disseminating tumor cells, assessing outcomes from the major prevention trials currently in progress, and improving methodologies to assess risks and benefits of treatment. Priorities for optimizing bone-targeted therapies include advancing studies of serum proteomics and genomics to reliably identify patients who will develop bone metastases, enhancing imaging for early detection of bone metastases and early response evaluation, and developing new tests to evaluate response to bone-directed treatments.