From the Guidelines
Renal cell carcinoma (RCC) can indeed metastasize to the bones, and this occurrence is associated with significant morbidity and mortality. According to the most recent and highest quality study, patients with bone metastases from metastatic clear cell renal cell carcinoma may benefit from bone-directed radiation if symptomatic, and bone resorption inhibitors (either bisphosphonate or RANKL inhibitor) when clinical concern for fracture or skeletal-related events is present 1.
Bone Metastases in RCC
The presence of bone metastasis is a significant concern in RCC, as it can lead to skeletal-related events (SREs) such as pathological fractures, the need for radiotherapy or surgery to bone, spinal cord compression, and hypercalcemia 1. These complications can result in substantial morbidity, reduced quality of life, and increased medical costs.
Treatment Approaches
Treatment for bone metastases from RCC typically involves a combination of approaches, including:
- Systemic therapy (e.g., targeted therapies, immunotherapy)
- Local treatments (e.g., radiation therapy, surgery)
- Bone-modifying agents (e.g., zoledronic acid or denosumab) to reduce SREs 1. The use of bone-modifying agents, such as zoledronic acid, has been shown to reduce SREs in patients with bone metastasis due to metastatic RCC (mRCC) 1.
Monitoring and Management
Patients with bone metastases should be monitored closely and may require pain management, orthopedic interventions, and regular imaging to assess disease progression. The ability of RCC to invade bones is due to its tendency to spread through the bloodstream and the favorable microenvironment that bones provide for cancer cell growth. The bone marrow's rich blood supply and growth factors can promote the survival and proliferation of cancer cells that reach the skeletal system.
Key Considerations
The most common sites for bone metastases from RCC include the spine, pelvis, ribs, and long bones of the arms and legs. These bone metastases can cause significant pain, increase the risk of fractures, and may lead to hypercalcemia (high calcium levels in the blood). Early detection and treatment of bone metastases are crucial to improving outcomes and reducing morbidity in patients with RCC.
From the FDA Drug Label
The most common site of metastases present at screening was the lung (78% versus 80%, respectively), followed by the lymph nodes (58% versus 53%, respectively) and bone (30% each arm); The answer is: Yes, renal cell carcinoma (RCC) can metastasize to the bones, as evidenced by the fact that 30% of patients in the study had bone metastases at baseline 2.
From the Research
Renal Cell Carcinoma and Bone Metastasis
- Renal cell carcinoma (RCC) can metastasize to the bones, with approximately one-third of patients with advanced RCC developing bone metastasis 3.
- Bone metastases from RCC are often osteolytic and can cause significant morbidity, including pain, pathologic fracture, spinal cord compression, and hypercalcemia 3.
- The presence of bone metastasis in RCC is associated with poor prognosis 3.
Treatment of Bone Metastasis from RCC
- A multimodal management strategy, including wide resection of lesions, radiotherapy, systemic therapy, and other local treatment options, can improve quality of life and survival in patients with RCC and bone metastases 4.
- Systemic treatments, such as tyrosine-kinase inhibitors and immunotherapy, may be effective in treating bone metastases from RCC 5.
- Bone-targeted treatment using bisphosphonate and denosumab can reduce skeletal complications in RCC, but does not cure the disease or improve survival 3.
- Targeted therapy or immune checkpoint inhibitors without radiotherapy may have only a slight effect on bone metastasis control 6.
Case Studies and Treatment Outcomes
- A case study reported a patient with RCC and multiple bone metastases who was successfully treated using a multidisciplinary approach, including systemic treatment with tyrosine kinase inhibitor, robot-assisted partial nephrectomy, and metastasectomy 7.
- Another study found that systemic therapy with radiotherapy had a higher overall response rate and longer time to progression of bone metastasis compared to systemic therapy without radiotherapy 6.