Palliative effects and adverse events of strontium-89 for prostate cancer patients with bone metastasis

Abstract

Abstract. The aim of the present study was to evaluate the palliative effects and adverse events of strontium-89 (Sr-89) in patients with bone metastasis from prostate cancer. A total of 18 patients with prostate cancer and painful bone metastases, as diagnosed on bone scintigraphy, who were treated with Sr-89 at the National Kyushu Cancer Center between February, 2008 and April, 2014 were reviewed. Of the 18 subjects, 13 (72.2%) achieved a pain response, whereas 5 were classified as pain non-responders (27.8%). According to a logistic regression analysis, the pre-administration characteristics, including age, prostate-specific antigen (PSA), alkaline phosphatase (ALP), history of bone-modifying agent administration, opioid use or palliative radiation therapy, time after the combined androgen blockade nadir and time since the pain onset, were not found to be significant predictors of the pain response. Similarly, the post-administration characteristics, including pain flares and the PSA and ALP response, were not found to be significant predictors of the pain response. Although no patients exhibited leukocyte toxicities, 2 patients experienced myelosuppression, involving anemia and thrombocytopenia, requiring transfusion of red cell or platelet concentrate following Sr-89 treatment. Of the 18 patients, 5 (27.8%) reported pain flares, all of whom were successfully treated with rescue drugs alone. According to the logistic regression analysis, of the pre-administration characteristics, only ALP was identified as a significant predictor of bone marrow suppression in the univariate and multivariate analyses (P=0.006). Therefore, Sr-89 treatment was found to be effective in ameliorating bone pain associated with metastasis from prostate cancer. Although it is difficult to identify the patients who will receive pain relief prior to Sr-89 administration, this drug should be administered during the early stages due to the potential for bone marrow suppression in patients with high ALP levels.

A Step-by-Step Guide for the Novel Radiometal Production for Medical Applications: Case Studies with 68Ga, 44Sc, 177Lu and 161Tb

“…Automated modules are regularly used to ensure consistency of labeling the radionuclide to the target to produce the radiopharmaceutical. The so-called GMP module is utilized for the pharmaceutical labeling of a limited number of radionuclides for clinical diagnosis and therapy, namely, 18 F, 11 C, 15 O, 13 N, 68 Ga, 99m Tc, 90 Y and 177 Lu [85][86][87][88].…”

“…Radiometals have been used extensively in clinical diagnostics over the last three decades, particularly, 99m Tc, 67 Ga and 111 In for SPECT and, more recently, 68 Ga, 89 Zr and 64 Cu for PET (Table 1). On the other hand" therapeutic radiometals in clinical use are limited to 177 Lu [8][9][10], 90 Y [11,12], 89 Sr [13,14] and 223 Ra [15,16]. 223 Ra is the only approved radionuclide by health authorities for targeted alpha therapy to extend survival [17].…”

Assessment of the severity of bone marrow suppression in patients with painful bone metastases treated with strontium-89

“…Porównując spadki wartości parametrów morfologii krwi obwodowej na wizytach kontrolnych z przedstawionymi w pracach innych autorów i stopniując toksyczność leczenia w obrębie szpiku kostnego zgodnie z kryteriami WHO, Furubayashi w badaniu 18 pacjentów z rozpoznaniem raka prostaty toksyczność 3. stopnia w zakresie spadku liczby płytek krwi stwierdził u jednego pacjenta (5,6% grupy badanej), a toksyczność 3. lub 4. stopnia w zakresie leukopenii -u żadnego z badanych pacjentów [9]. Ye i wsp.…”

Ra-223 Treatment for Bone Metastases in Castrate-Resistant Prostate Cancer

“…EBRT plus the β-emitter samarium-153 (Sm-153) has been shown to be beneficial relative to Sm-153 alone; the toxicity of the combination was similar to Sm-153 monotherapy 10. Strontium-89 (Sr-89), another β-emitter, has demonstrated efficacy to treat the bone metastases associated with CRPC, due to its ability to accumulate in bone metastases 11,12. Denosumab and zoledronic acid delay development of skeletal-related events (SREs) and are FDA-approved in mCRPC, but neither prolongs survival 13–15…”