Rhenium-186 hydroxyethylidene diphosphonate for the treatment of painful osseous metastases

Maxon, Harry R.; Thomas, Stephen R.; Hertzberg, Vicki; Schroder, Louis E.; Englaro, Emanuela; Samaratunga, Ranasinghage C.; Scher, Howard I.; Moulton, Jonathan S.; Deutsch, Edward; Deutsch, Karen; Schneider, Harold J.; Williams, Craig C.; Ehrhardt, Gary J.

doi:10.1016/s0001-2998(05)80155-2

Cited by 97 publications

(49 citation statements)

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“…These values are comparable with the dosimetry for 186 Re-HEDP (26 Gy for the bone metastases and 1.8 Gy for the red bone marrow) and also with the therapeutic effect and the bone marrow toxicity of 186 Re-HEDP (Maxon et al, 1990(Maxon et al, , 1998.…”

supporting

confidence: 82%

“…In the literature there are few reports about the therapeutic efficiency of 188 Re-HEDP in only small patient groups (Maxon et al, 1998;Palmedo et al, 2000), which reported a response rate of 70 -80%. In 23 patients with bone metastases from a variety of primary tumours, 188 Re-HEDP therapy was able to reduce analgesic intake in 82% of patients (Chen, 2000).…”

Section: Discussionmentioning

confidence: 99%

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Therapeutic efficiency of rhenium-188-HEDP in human prostate cancer skeletal metastases

et al. 2003

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Rhenium-188-HEDP (Re generator, it is convenient for clinical therapeutic use with a short physical half-life of 16.9 h and a maximal b-energy of 2.1 MeV. We investigated the effect of 188 Re-HEDP on pain relief, analgesic intake and impairment of bone marrow function in 27 patients with bone metastases induced from prostate cancer. All patients were interviewed using a standardised set of questions before, and after therapy for 12 weeks. The patients were treated with 2700 -3459 MBq of 188 Re-HEDP. Blood samples were taken weekly for 12 weeks, and a blood count was performed. Patients described an improvement on the Karnofsky performance scale from 7477 to 8579% 12 weeks after therapy (P ¼ 0.001). The pain score showed a maximum decrease from 44718 to 27720% in the third to the eight week after therapy (P ¼ 0.009). Seventy-six percent of the patients described a pain relief without increase of analgesic intake. Twenty percent of the patients could discontinue their analgesics and were pain free. Mean platelet count decreased from (286775) * 10 3 ml À1 to (215792) * 10 3 ml À1, and mean leucocyte count from (7.771.5) * 10 3 ml À1 to (6.071.9) * 10 3 ml À1 in the second to the fourth week after therapy. The maximal differences between the values of platelets and leucocytes before and after therapy were not statistically significant (P ¼ 0.021 and 0.094). In conclusion, 188Re-HEDP is an effective radiopharmaceutical used in the palliative treatment of metastatic bone pain in prostate cancer and shows minimal bone marrow toxicity.

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confidence: 82%

Section: Discussionmentioning

confidence: 99%

Therapeutic efficiency of rhenium-188-HEDP in human prostate cancer skeletal metastases

et al. 2003

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“…Ablating a large remnant with 131 I is not recommended, because it causes radiation thyroiditis with pain and swelling, and may cause thyrotoxicosis. Also, a large thyroid remnant prevents TSH concentrations from increasing above 30 mU/l after the levothyroxine withdrawal that is necessary for tumor 131 I uptake (Goldman et al 1980), without which incomplete tumor ablation results (Burmeister et al 1991, Maxon et al 1992.…”

Section: Completion Thyroidectomymentioning

confidence: 99%

Management of papillary and follicular (differentiated) thyroid cancer: new paradigms using recombinant human thyrotropin.

Mazzaferri¹,

Massoll²

2002

Endocrine-Related Cancer

163

113

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The incidence of differentiated thyroid cancer (DTC) has increased in many places around the world over the past three decades, yet this has been associated with a significant decrease in DTC mortality rates in some countries. While the best 10-year DTC survival rates are about 90%, long-term relapse rates remain high, in the order of 20-40%, depending upon the patient's age and tumor stage at the time of initial treatment. About 80% of patients appear to be rendered disease-free by initial treatment, but the others have persistent tumor, sometimes found decades later. Optimal treatment for tumors that are likely to relapse or cause death is total thyroidectomy and ablation by iodine-131 ( 131 I), followed by long-term levothyroxine suppression of thyrotropin (TSH). On the basis of regression modeling of 1510 patients without distant metastases at the time of initial treatment and including surgical and 131 I treatment, the likelihood of death from DTC is increased by several factors, including age > 45 years, tumor size > 1.0 cm, local tumor invasion or regional lymph-node metastases, follicular histology, and delay of treatment > 12 months. Cancer mortality is favorably and independently affected by female sex, total or near-total thyroidectomy, 131 I treatment and levothyroxine suppression of TSH. Treatments with 131 I to ablate thyroid remnants and residual disease are independent prognostic variables favorably influencing distant tumor relapse and cancer death rates. Delay in treatment of persistent disease has a profound impact on outcome.Optimal long-term follow-up using serum thyroglobulin (Tg) measurements and diagnostic whole-body scans (DxWBS) require high concentrations of TSH, which until recently were possible to achieve only by withdrawing levothyroxine treatment, producing symptomatic hypothyroidism. New paradigms, however, provide alternative pathways to prepare patients for 131 I treatment and to optimize follow-up. Patients with undetectable or low Tg concentrations and persistent occult disease can now be identified within the first year after initial treatment by recombinant human (rh)TSH-stimulated serum Tg concentrations greater than 2 µg/l, without performing DxWBS. These new follow-up paradigms promptly identify patients with lung metastases that are not evident on routine imaging, but which respond to 131 I treatment. In addition, rhTSH can be given to prepare patients for 131 I remnant ablation or 131 I treatment for metastases, especially those who are unable to withstand hypothyroidism because of concurrent illness or advanced age, or whose hypothyroid TSH fails to increase.

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“…Flare reactions can be managed by analgesics or steroid agents (30). An incidence of 10%-30% has been reported with 186 Re-HEDP (13,(31)(32)(33)(34) and up to 50% with 188 Re (19). In our study, flare reactions occurred in 63% of patients and could have been due to the patients' awareness of the probable short-term worsening of bone pain, higher administered dose, or greater fluctuations in the level of pain.…”

Section: Discussionmentioning

confidence: 55%

“…Various bone-seeking b-emitting radiopharmaceuticals have been developed, including 32 P, 89 Sr, 153 Sm-ethylenediaminetetramethylene phosphoric acid, 186 Re-1-hydroxyethylidene-1,1-diphosphonate (HEDP), and 188 Re-HEDP. 186 Re is a promising radionuclide with a physical half-life of 89.3 h, maximum b-emission of 1.07 MeV, and 9% abundant g-emission of 137 keV, making it suitable for imaging and dosimetry (9,10).…”

mentioning

confidence: 99%

Phase 2 Study of a High Dose of 186Re-HEDP for Bone Pain Palliation in Patients with Widespread Skeletal Metastases

Pirayesh

Amoui

Mirzaee

et al. 2013

Journal of Nuclear Medicine Technology

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186 Re-1-hydroxyethylidene-1,1-diphosphonate (HEDP) is an attractive radiopharmaceutical for the treatment of bone pain arising from skeletal metastatic lesions. Currently, 186 Re-HEDP is most commonly used in European countries. The aim of this study was to investigate the palliative efficacy and adverse effects of 186 Re-HEDP in patients with different types of cancers and skeletal bone pain. Methods: Nineteen (8 male, 11 female) patients with various cancers (breast, prostate, renal cell carcinoma, colon, and neuroendocrine tumors) and painful bone metastases were included in the study. A dose of 1,480-3,330 MBq (40-90 mCi) of 186 Re-HEDP was administered intravenously. The patients' level of pain relief was assessed by the Visual Analog Scale for 8 wk after treatment and by a weekly blood cell count to evaluate for hematologic toxicity. Results: The overall response rate was 89.5%, and the mean pain score assessed by the Visual Analog Scale was reduced from 9.1 to 5.3 after 1 wk (P 5 0.003). No adverse effects were reported by patients during intravenous administration or for up to 24 h after administration. A flare reaction was seen in 63.2% of patients, mainly during days 1-3, and lasted for 2-4 d. There was no significant correlation between the response to therapy and the flare reactions (P . 0.05). The nadir of platelet reduction occurred at the fourth or fifth week and led to platelet infusion in only 4 patients with a low baseline platelet count and diffuse skeletal metastases. Bone marrow suppression occurred in patients receiving higher doses, but no clinical problems were seen except in 2 patients who required packed cell transfusion similar to their prior transfusions. Conclusion: 186 Re-HEDP is an effective radiopharmaceutical for the palliative treatment of metastatic bone pain and has minimal adverse effects.Key Words: rhenium 186(tin) etidronate; pain palliation; bone metastasis Nucl Med Technol 2013; 41:192-196 DOI: 10.2967/jnmt.113.124297 The skeleton is the most common site of metastatic disease, and tumors arising from the breast, prostate, lung, thyroid, and kidney commonly spread to bone. The frequency of bone metastases has been estimated at 65%-75% in patients with breast and prostate cancer (1,2) and about 30%-40% in those with lung cancer (3). Bone pain, as the main symptom of skeletal metastases and the most common type of cancer-related pain, obviously has a negative impact on quality of life (4). Currently, the factors contributing to cancer pain are not completely understood (5,6), and metastatic bone pain might be poorly localized for external radiation therapy (7). Various modalities have been introduced for the treatment of bone metastases, including analgesics, hormone therapy, cytotoxic drugs, biphosphonates, and surgery; however, they are not effective in all patients with painful refractory skeletal metastases. An alternative approach is systemic administration of radiopharmaceuticals, which is a valuable and effective method for relieving bone pain in patients with ...

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Rhenium-186 hydroxyethylidene diphosphonate for the treatment of painful osseous metastases

Cited by 97 publications

References 15 publications

Therapeutic efficiency of rhenium-188-HEDP in human prostate cancer skeletal metastases

Therapeutic efficiency of rhenium-188-HEDP in human prostate cancer skeletal metastases

Management of papillary and follicular (differentiated) thyroid cancer: new paradigms using recombinant human thyrotropin.

Phase 2 Study of a High Dose of 186Re-HEDP for Bone Pain Palliation in Patients with Widespread Skeletal Metastases

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