肿瘤学中的骨骼健康：通过多学科协作界定生物类似药地舒单抗的应用。
完整摘要 · 中文译文
骨转移是晚期实体肿瘤中发病率的主要来源，导致骨骼相关事件（SREs）、疼痛和生活质量受损。尽管指南推荐使用骨改良药物（BMAs）来预防SREs，但真实世界数据一致显示这些药物的启动延迟、给药剂量不一致且治疗持续性差。这种持续的治疗不足导致了可预防的骨骼并发症、更高的医疗资源利用和更差的患者结局。地舒单抗和双膦酸盐仍是骨靶向治疗的基石。近期证据表明，持续使用BMA与保留功能状态、减轻骨痛以及可能改善生存率密切相关。然而，可及性和可负担性在许多环境中继续限制其最佳使用。地舒单抗生物类似药的引入为解决这些障碍提供了重要机会。由Sandoz、Samsung Bioepis、Celltrion和Fresenius Kabi开发的多项地舒单抗生物类似药III期试验显示，其与参比地舒单抗在疗效、安全性和免疫原性方面等效，腰椎骨矿物质密度增加幅度相当，不良事件发生率低。预算影响模型预测可大幅节省成本并扩大患者可及性，强化了其在减少经济毒性和促进更公平的骨骼健康照护中的作用。骨转移的最佳管理需要肿瘤科医生、牙科医生、护士、药剂师、放射科医生、康复专家等多学科协调照护。 支持与姑息治疗团队。这种合作确保了及时启动骨调节剂（BMA）、预防性牙科评估、依从性监测以及跨全身治疗线治疗的连续性。将生物类似药整合到结构化的、以患者为中心的护理路径中，为弥补现有治疗差距并改善骨转移患者的预后提供了一种可持续的策略。
完整摘要 · 英文原文
Bone metastases represent a major source of morbidity in advanced solid tumors, leading to skeletal-related events (SREs), pain, and impaired quality of life. Although guidelines recommend the use of bone-modifying agents (BMAs) to prevent SREs, real-world data consistently show delayed initiation, inconsistent dosing, and poor treatment persistence for these agents. This ongoing undertreatment contributes to preventable skeletal complications, greater healthcare utilization, and diminished patient outcomes. Denosumab and bisphosphonates remain the cornerstone of bone-targeted therapy. Recent evidence indicates that sustained BMA use is strongly associated with preserved functional status, reduced bone pain, and potentially improved survival. However, access and affordability continue to limit optimal use in many settings. The introduction of denosumab biosimilars offers an important opportunity to address these barriers. Phase III trials across multiple denosumab biosimilars developed by Sandoz, Samsung Bioepis, Celltrion, and Fresenius Kabi have shown equivalent efficacy, safety, and immunogenicity to the reference denosumab, with comparable lumbar spine bone mineral density gains and low rates of adverse events. Budget-impact modeling projects substantial cost savings and expanded patient access, reinforcing their role in reducing financial toxicity and promoting more equitable bone health care. Optimal management of bone metastases requires coordinated, multidisciplinary care involving oncologists, dentists, nurses, pharmacists, radiologists, rehabilitation specialists, supportive and palliative care teams. Such collaboration ensures timely BMA initiation, preventive dental evaluation, adherence monitoring, and continuity of therapy across systemic treatment lines. Integrating biosimilars within structured, patient-centered care pathways offers a sustainable strategy to close existing treatment gaps and improve outcomes for patients with bone metastases.