In the oncology section of this issue of Orthopedic Clinics of North America , we learn about Paget disease, a common skeletal disorder. In the review, “Paget Disease of Bone,” Dr Al-Rashid and his colleagues from the Orthopaedic Oncology Service at Massachusetts General Hospital discuss the pathophysiology and treatment of Paget disease. The authors cover the possible genetic and environmental causes of the disease, appropriate diagnostic use of laboratory and imaging studies, current recommendations for medical therapy, and considerations for orthopedic surgeons operating on patients with Paget disease.
In “Targeted Chemotherapy in Bone and Soft-Tissue Sarcoma,” the authors review the most commonly targeted pathways in sarcoma and a selection of targeted therapies showing initial promise or approaching clinical use. Dr Harwood and his colleagues from the Arthur James Cancer Hospital at The Ohio State University start by reviewing the unsatisfactory state of current systemic therapy options for the most common bone and soft tissue sarcomas. They then review the major and minor pathways involved in sarcomagenesis, which have yielded potential targets for therapy. For some of these pathways, such as Hedgehog and IGF, inhibition of tumor growth has been demonstrated in vitro. Other targets, such as mTOR and VEGF, have agents that have progressed to phase II and even phase III trials, with response seen in multiple sarcoma subtypes.