Tumour-derived factors attract and stimulate osteoclasts, increasing bone turnover and releasing bone-activated growth factors and cytokines Metastatic tumour development is thought to follow complex interactions between the tumour cell and the bone microenvironment allowing occupation of the haematopoietic stem cell and other cellular niches in the bone marrow by tumour cells. ISRCTN, ISRCTN92755158, Registered on 17 February 2016.ĭespite significant advances and improvements in outcomes following breast cancer, a significant proportion of patients still develop metastatic disease with bone being the most common first site for distant metastasis. If the results find acceptable rates of toxicity with a decrease in bone turnover markers, further work will be necessary in a phase II/III setting to assess the efficacy and clinical benefit. The CARBON study is important as the results will be the first to assess radium-223 with chemotherapy in advanced breast cancer. ![]() Methods/designĬARBON is a UK-based, open-label, multi-centre study which comprises an initial safety phase to establish the feasibility and safety of combining radium-223 given on a 6-weekly schedule in combination with orally administered capecitabine followed by a randomised extension phase to further characterise the safety profile and provide preliminary estimation of efficacy. Combining systemic therapy with a bone-targeted agent, such as radium-223, may provide an effective treatment with minimal additional side effects. However, there remains a need for further treatment options for patients with bone metastases. Treatment of bone metastases currently focusses on symptom relief and prevention and treatment of skeletal complications. Bone is the most common first site of metastatic disease accounting for 40% of all first recurrence and 70% of patients with advanced disease develop skeletal involvement. ![]() A substantial proportion of breast cancer patients develop metastatic disease, with over 450,000 deaths globally per year.
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