Predictive implications of bone turnover markers after palliative treatment with 186Re-HEDP in hormone-refractory prostate cancer patients with painful osseous metastases

Zafeirakis, Athanasios; Papatheodorou, Georgios; Arhontakis, Athanasios; Γουλιάμος, Αθανάσιος; Vlahos, Lambros; Limouris, Georgios S.

doi:10.1007/s00259-009-1243-5

Cited by 15 publications

(14 citation statements)

References 34 publications

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“…In our study, 78.9% of patients experienced bone pain relief, and a therapeutic efficiency of 50%-92% has been reported with low-dose 186 Re-HEDP in different malignancies (13,14). This variation could be related to some heterogeneous factors such as patient selection criteria, tumor type, response criteria, and the method of administration.…”

Section: Discussionmentioning

confidence: 88%

“…Patient showed complete response to therapy and flare reaction after receiving 2,960 MBq of 186 Re-HEDP. bone markers, hemoglobin level, and previous treatments (14,23,24,36), but highly controversial issues remain. Although several studies have demonstrated that earlier treatment in patients in better clinical condition may improve the response rate (22)(23)(24), unfortunately radionuclide therapy is underutilized in Iran.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

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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“…Furthermore, Zafeirakis A et al [11] evaluated patients with hormone refractory prostate cancer and BM. They concluded that in this context NTx was useful when it comes to distinguishing the patients with bone pain who respond to the palliative treatment with biphosphonates from those who do not.…”

Section: Discussionmentioning

confidence: 99%

Serum crosslinked-N-terminal telopeptide of type I collagen (NTx) has prognostic implications for patients with initial prostate carcinoma (PCa): A pilot study

Jablonka

Alves

Oliveira

et al. 2014

Clinica Chimica Acta

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“…Recent studies also have begun to explore correlations between bone marker level changes and response to palliative radionuclide treatment [35]. In a pilot study in men with painful osseous metastases from prostate cancer receiving palliative Re-186 treatment, a post-treatment NTX level decrease of at least 20% correlated with 3.4-fold belter palliation of bone pain (vs. men with <20% reduction in NTX levels; P = 0.0005) [35].…”

Section: Potential Insights From Bone Marker Assessments Throughoumentioning

confidence: 99%

“…In a pilot study in men with painful osseous metastases from prostate cancer receiving palliative Re-186 treatment, a post-treatment NTX level decrease of at least 20% correlated with 3.4-fold belter palliation of bone pain (vs. men with <20% reduction in NTX levels; P = 0.0005) [35]. Although this study involved a small number of patients, the findings are important because none of the patients received any other therapies that could affect bone metabolism [35]. …”

Section: Potential Insights From Bone Marker Assessments Throughoumentioning

confidence: 99%

Biochemical markers of bone turnover and clinical outcomes in men with prostate cancer

Saad

Eastham

Smith

2012

Urologic Oncology: Seminars and Original Investigations

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Objectives-Disrupted skeletal homeostasis is common in patients with prostate cancer. Low bone density is common at diagnosis, and fracture risk is further elevated by the effects of androgen-deprivation therapy. Later in the disease course, bone metastases can result in skeletal morbidity. Although prostate-specific antigen (PSA) levels can provide important insights into overall disease progression, convenient, noninvasive tools for monitoring skeletal health are lacking. Biochemical markers released into serum and urine as a result of bone turnover might fulfill this unmet need. The objectives of this article are to assess current evidence examining the potential utility of bone turnover markers for monitoring skeletal health. bone disease progression, and response to antiresorptive therapies in the prostate cancer setting.Methods-Published articles and abstracts from major oncology or urology congresses pertaining to the use of bone turnover markers to monitor skeletal health and disease progression were identified and assessed for relevance and methodologic stringency.Results-Several randomized trials and correlative studies support the utility of bone marker level changes to assess disease progression in the metastatic setting, bone health during hormonal therapy, and response to bisphosphonate therapy. The available data support potential associations between levels of the collagen type I telopeptides (NTX and CTX) and the severity of metastatic bone disease as well as outcomes during antiresorptive therapy. Evidence linking bone marker level changes with early diagnosis of skeletal metastases is emerging. Although several markers have shown promising results in correlative studies, results from ongoing prospective trials are needed to establish the role of bone markers in this setting.Conclusions-Bone marker levels reflect ongoing skeletal metabolism and can provide important insights into bone health and response to bisphosphonate therapy in patients with prostate cancer. The data supporting a role for bone markers to monitor skeletal disease progression and response to zoledronic acid therapy are especially strong. Bone marker assessments may complement established diagnostic and monitoring paradigms in prostate cancer.

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Predictive implications of bone turnover markers after palliative treatment with 186Re-HEDP in hormone-refractory prostate cancer patients with painful osseous metastases

Cited by 15 publications

References 34 publications

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

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

Serum crosslinked-N-terminal telopeptide of type I collagen (NTx) has prognostic implications for patients with initial prostate carcinoma (PCa): A pilot study

Biochemical markers of bone turnover and clinical outcomes in men with prostate cancer

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