Potential Treatments for Metastatic Spine Tumors Using Biomarkers

Ramos laie^*
*Correspondence: Ramos laie, Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, RI 02903, USA, Email:

Introduction

Metastatic spine tumors represent a severe and challenging complication of advanced cancers, as up to 40% of patients with systemic cancer develop spinal metastases during the course of their disease. These tumors can cause debilitating pain, neurological deficits, and reduced quality of life due to their impact on the spinal cord and vertebral structure. The primary cancers that most commonly metastasize to the spine include breast, lung, prostate, and renal cancers. Recent advancements in oncology have shifted the focus from broad-spectrum treatments to more targeted, personalized approaches. In this context, biomarkers have emerged as crucial tools for guiding therapy in metastatic spine tumors. Biomarkers are measurable indicators of biological processes or disease states and can include genes, proteins, and other molecules. They provide valuable insight into the tumor's behavior, predict response to treatments, and help in selecting the most effective therapeutic strategies. This article delves into the potential treatments for metastatic spine tumors, focusing on the use of biomarkers to inform and improve therapeutic approaches. It will explore current treatment options, the role of biomarkers in guiding these treatments, and the future direction of biomarker-driven therapies in metastatic spine tumors.

Metastatic spine tumors are secondary cancers that originate from distant primary tumors and spread to the spine through hematogenous dissemination. The spine is a frequent site of metastasis due to its rich vascular supply, and the vertebral bodies are the most commonly affected areas. These metastases can result in spinal instability, pathological fractures, and spinal cord compression, which can lead to pain, paralysis, and other severe complications. The treatment of metastatic spine tumors is complex, involving a multidisciplinary approach that includes neurosurgery, orthopedic surgery, radiation oncology, and medical oncology. The goals of treatment are to relieve pain, maintain or improve neurological function, stabilize the spine, and control tumor growth. However, selecting the most appropriate treatment requires a deep understanding of the tumor's biological characteristics, which can be gleaned through the use of biomarkers. Surgery remains a critical option for patients with metastatic spine tumors, particularly in cases where there is spinal instability, neurological deficits, or intractable pain. The goals of surgery include decompression of the spinal cord and nerve roots, stabilization of the spine, and, in some cases, resection of the tumor. Surgical techniques have advanced over the years, with minimally invasive approaches and advanced instrumentation improving patient outcomes. However, surgery is often palliative rather than curative in metastatic spine tumors, given the systemic nature of the disease. Radiation can provide excellent pain relief and tumor control, especially when combined with systemic therapies [1-3].

Description

Bisphosphonates, such as zoledronic acid, are used to inhibit bone resorption and reduce skeletal-related events in patients with bone metastases. Biomarkers of bone resorption can help identify patients who are likely to benefit from bisphosphonate therapy. Denosumab is a monoclonal antibody that targets RANKL, a key mediator of bone resorption. It has shown efficacy in reducing SREs in patients with bone metastases from a variety of cancers. Elevated levels of bone resorption biomarkers may indicate a greater likelihood of benefit from denosumab therapy. : In patients with ER-positive and PR-positive breast cancer metastases to the spine, hormone therapies such as tamoxifen or aromatase inhibitors can be effective in controlling tumor growth. These therapies work by blocking the hormones that fuel cancer growth. In cases where tumors become resistant to hormone therapy, biomarkers such as HER2 (human epidermal growth factor receptor 2) may guide the use of targeted therapies like trastuzumab (Herceptin). In metastatic prostate cancer, AR status is a key biomarker.

Androgen deprivation therapy is the standard treatment for AR-positive prostate cancer metastases, including those in the spine. Newer agents such as abiraterone and enzalutamide, which target androgen receptor signaling more effectively, have improved outcomes in patients with metastatic castration-resistant prostate cancer. Lung cancer is another leading cause of metastatic spine tumors, and molecular biomarkers such as epidermal growth factor receptor mutations and anaplastic lymphoma kinase rearrangements have revolutionized the treatment of metastatic non-small cell lung cancer. Patients with EGFR-mutant NSCLC have shown significant responses to EGFR tyrosine kinase inhibitors such as erlotinib, gefitinib, and osimertinib. These targeted therapies can provide durable responses in patients with spinal metastases from EGFR-mutant lung cancer, improving both quality of life and survival. ALK-positive NSCLC is another subset of lung cancer that responds well to targeted therapy. ALK inhibitors such as crizotinib, ceritinib, and alectinib have demonstrated efficacy in controlling metastatic disease, including spinal metastases, by targeting the specific genetic alterations driving tumor growth [4,5].

Conclusion

Multiple studies have demonstrated the positive impact of spinal decompression on lower limb function in patients with spinal OA. In a large cohort study of patients undergoing laminectomy for lumbar stenosis, over 80% reported significant improvements in leg pain and motor function within six months of surgery. Long-term follow-up revealed sustained improvements in lower limb strength and mobility, with many patients returning to normal activities, including walking and exercise. However, it is important to recognize that patient selection is critical for the success of decompression surgery. Patients with severe spinal deformities or instability may require a combination of decompression and instrumentation to achieve optimal outcomes.

Acknowledgement

None.

Conflict of Interest

None.

References

1. Fridley, Jared S., Sohail Syed, Tianyi Niu and Owen P. Leary, et al. "Presentation of spinal cord and column tumors." Neuro Oncol 7 (2020): 18-24.

   Google Scholar, Crossref, Indexed at

2. Fares, Jawad, Mohamad Y. Fares, Hussein H. Khachfe and Hamza A. Salhab, et al. "Molecular principles of metastasis: A hallmark of cancer revisited." Signal Transduct Target Ther 5 (2020): 28.

   Google Scholar, Crossref, Indexed at

3. Malone, Eoghan R., Marc Oliva, Peter JB Sabatini and Tracy L. Stockley, et al. "Molecular profiling for precision cancer therapies." Genome Med 12 (2020): 1-19.

   Google Scholar, Crossref, Indexed at

4. Patchell, Roy A., Phillip A. Tibbs, William F. Regine and Richard Payne, et al. "Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: A randomised trial." The Lancet 366 (2005): 643-648.

   Google Scholar, Crossref, Indexed at

5. Sun, Jun, Lingling Hu, Seoyeon Bok and Alisha R. Yallowitz, et al. "A vertebral skeletal stem cell lineage driving metastasis." Nature 621 (2023): 602-609.

   Google Scholar, Crossref, Indexed at