Palliative treatment of bone metastases with samarium-153 EDTMP at onset of pain

Abstract

We evaluated the pain response and daily discomfort in patients suffering from a borderline degree of bone pain due to breast or lung cancer bone metastases, who had undergone early palliative radionuclide treatment. The results were compared with those from patients who had received standard analgesic therapy. Twenty-one patients (65.7 ± 3 years; 17 women) with metastatic bone cancer underwent samarium-153 (Sm-153) ethylene diamine tetramethylene phosphonate (EDTMP) administration (group A) and 18 patients (64.3 ± 8 years; 16 women)continued to receive standard analgesics (group B; control group). The patients kept a daily pain diary assessing both their discomfort and the pain at specific sites by means of a visual analog scale, rating from 0 (no discomfort–no pain)to 10 (worst discomfort–pain). These diaries were reviewed weekly for 2 months and three physicians rated the pain response on a scale from -2 (considerable deterioration) to +2 (considerable improvement). Baseline characteristics were similar in both groups. The reduction of total discomfort and of bone pain in group A was significantly greater compared to group B (p < 0.0001). A significant improvement of clinical conditions was observed in group A, where the physician rate changed from -1 to 1, compared to group B in which the rate changed from -1 to 0. Sm-153 EDTMP therapy can be considered for patients with bone pain from breast and lung cancer in advance, i.e.,before the establishment of severe pain syndrome.

Targeted Palliative Radionuclide Therapy for Metastatic Bone Pain

“…Historically, regarding the merely palliative effects of traditional β¯-emitters, radiopharmaceuticals become a part of patient treatment when physicians are at the end of their rope and the life expectancy is poor. However, this approach may change in the guidelines, in the future, regarding: first, β¯-emitters are more effective when they are used in early stages and limited skeletal involvement and when the patient’s performance state is higher [ 74 , 85 ]; second, the combination therapy is being more evaluated and demonstrate promising results. Other than chemo- or radiotherapy, combination with bisphosphonates or denosumab, a RANK ligand inhibitor, are barley investigated; third, it is well-known that α-emitters are more toxic for tumoral cells and show significant survival benefits.…”

“…However, the studies are not sufficient to suggest a definite conclusion. Also, earlier initiation of [ 153 Sm]Sm–EDTMP may be more effective [ 74 ]. Hence, the optimal timing of administration of [ 153 Sm]Sm–EDTMP requires further assessment.…”

Bone Health Management in the Continuum of Prostate Cancer Disease

“…Both α- and β-particles emitting radiopharmaceuticals deliver radiation directly and specifically to cancer cells. α-(Radium 223) and β-particles (strontium-89) (Sr-89) chloride and samarium-153-emitting radiopharmaceuticals are used for the palliation of pain caused by bone metastases from PCa [ 159 , 160 , 161 , 162 , 163 , 164 , 165 , 166 , 167 ]. Radiopharmaceuticals have been underutilized in clinical practice because of their notable side effects which include myelosuppression and mutagenesis [ 168 ].…”

Lutetium-177-PSMA therapy for prostate cancer patients—a brief overview of the literature

“…Subsequently, to improve uptake and sensitivity, the potential of the [ 177 Lu]Lulabelled PSMA monoclonal antibody J-591, was investigated [9]. In a phase I and phase II study, this compound was found to have modest effect and was found to be associated with serious myelosuppression, as were all other aforementioned bonetargeting radioligand therapies [10][11][12]. The perspective on RLT [13,14].…”