Bisphosphonates in renal cell carcinoma: Palliation versus antitumor effects

Management of bone metastases from renal cell carcinoma (RCC) is a challenge compared with some other malignancies. The management involves multidisciplinary approaches. The mainstay of therapy aimed at bone metastases is bisphosphonates and other agents that stabilize osteoclasts. Large trials of bisphosphonates demonstrated benefit in terms of preventing or delaying skeletal-related events and the associated comorbidities related to bone metastases. The limited disease-specific data in RCC suggest that there is benefit from bisphosphonates in delaying skeletal-related events and reducing symptoms. While the role of bisphosphonates remain largely palliative, it is interesting to note that there has been demonstration of direct antitumoral and antiangiogenic effects secondary to bisphosphonate use. Combining tyrosine kinase inhibitors with bisphosphonates is an area that needs to be studied extensively to evaluate the potential for any synergy and any safety issues in RCC patients.