The history of cancer pain and bone-targeted agents: 10 most commonly asked questions

Cláudia Margarida Pereira Vieira,1–3 Maria Fragoso,1,4 Marta Ferreira,1 Filipa Ferreira Pereira,1 Deolinda Pereira,1 Rui Medeiros2,3,5,6 1Medical Oncology Department, Instituto Português de Oncologia do Porto Francisco Gentil (IPO-PORTO), Porto, Portugal; 2Research Center, Molecular Oncology Group Instituto Português de Oncologia do Porto Francisco Gentil (IPO-PORTO), Porto, Portugal; 3Faculty of Medicine, University of Porto, Porto, Portugal; 4Unit of Study and Treatment of Pain, Instituto Português de Oncologia do Porto Francisco Gentil (IPO-PORTO), Porto, Portugal; 5Biomedical Research Center, Faculty of Health Sciences, Fernando Pessoa University, Porto, Portugal; 6Research Department, Portuguese League Against Cancer, Porto, Portugal Abstract: The prevalence of pain and skeletal complications of metastatic bone disease is high and an important factor, which contributes to decreased quality of life and low survival rate. Bone-targeted agents are well-established therapies to reduce the skeletal-related events in patients with bone metastasis. However, the analgesic effect of these medications is still controversial. The objective of this review is to summarize the existing evidence about the use of bone-targeted agents in the treatment of metastatic bone pain, trying to answer to the 10 most commonly asked questions in this matter. To achieve this goal, authors did a research of reviews published between January 2001 and January 2018, using the terms MeSH: “cancer pain” and bisphosphonates. The source used was the PubMed (NLM) database. The search yielded 36 reviews, but only 16 met the inclusion criteria. Even with the introduction of a new class of drugs, bisphosphonates and specially zoledronic acid are the most commonly used drugs in most oncology centers. Bisphosphonates and denosumab appear to be beneficial in preventing skeletal morbidity but their analgesic role and impact on quality of life and survival are not so well established. Keywords: cancer pain, bisphosphonates, bone metastasis, palliative care, bone-targeted agents, denosuma