Tumor microenvironment is critical to the growth of breast cancer cells in bones. Excessive activity of osteoclasts, induced by a low-estrogen state, result in the production of growth factors that promote growth of cancer cells. Bisphosphonates induce apoptosis of osteoclasts, and consequently, alter the premetastatic niche in bones (1). The seminal trial by Diel et al. in 1998 demonstrated that clodronate reduced the incidence of bone metastases in women with early-stage breast cancer and bone marrow positive for circulating tumor cells (2). Subsequent clinical trials of bisphosphonates as adjuvant therapy for breast cancer conducted over the past 20 years have shown mixed results (3).

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选择双膦酸盐作为乳腺癌的辅助疗法：这很重要吗？

肿瘤微环境对骨骼中乳腺癌细胞的生长至关重要。由低雌激素状态引起的破骨细胞的过度活性导致产生促进癌细胞生长的生长因子。双膦酸盐诱导破骨细胞凋亡，并因此改变骨骼中转移前的生态位（1）。Diel等人的开创性试验。1998年的研究证明，氯膦酸盐可降低患有早期乳腺癌和骨髓中循环肿瘤细胞阳性的女性的骨转移发生率（2）。在过去的20年中，随后进行的双膦酸盐类作为乳腺癌辅助治疗的临床试验显示出好坏参半（3）。