Predictors of Response to Strontium-89 (Metastron®) in Skeletal Metastases from Prostate Cancer: Report of a Single Centre's 10-Year Experience

Windsor, Phyllis

doi:10.1053/clon.2001.9257

Cited by 18 publications

(16 citation statements)

References 15 publications

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“…However, in those patients that responded favorably to radionuclide treatment in the present study, median survival was signifi cantly improved from 6.9 to 9.8 months. The better survival for responders is in accordance with earlier studies [13] . Since anemia correlated with poor pain response and this was associated with shorter survival, it is most likely that patient selection accounts for the longer survival in responding patients [25] .…”

Section: Discussionsupporting

confidence: 92%

“…These fi ndings suggest that earlier treatment for patients in a better condition and with a higher hemoglobin concentration may improve response rates. This is also supported by studies that identifi ed patients with minimal osseous metastases and lower PSA to be more likely to respond favorably to radionuclide treatment [7,[11][12][13] . Although hemoglobin concentration predicted pain response in our analysis, earlier reported predictors of poor pain response such as extensive osseous bone metastases and poor PSA response [10] were not predictive in the present analysis as well as in other reports [5,14] .…”

Section: Discussionmentioning

confidence: 66%

“…These characteristics, however, are less useful to select patients for treatment. Others found higher response rates in patients with less extensive osseous involvement [7,[11][12][13] , but these fi ndings were not confi rmed by others [5,14] .…”

Section: Sr89 and Re186-hedp In Prostate Cancermentioning

confidence: 89%

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Serum Hemoglobin Levels Predict Response to Strontium-89 and Rhenium-186-HEDP Radionuclide Treatment for Painful Osseous Metastases in Prostate Cancer

Poel

Antonini²,

Hoefnagel³

et al. 2006

Urol Int

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Objective: Retrospective comparative analysis of strontium-89 chloride (Sr89) and rhenium-186-hydroxyethylidene diphosphonate (Re186-HEDP) radionuclide treatment to find predictors of response in patients with painful metastases from hormone refractory prostate cancer. Patients and Methods: Clinical data from 60 hormone refractory PCA patients (i.e. rising PSA at castrate testosterone serum levels) was obtained. Twenty-nine were treated with Sr89, 31 were treated with Re186-HEDP for painful osseous metastasis. Response was defined as a patient-reported decrease in pain and/or reduction in pain medication with stable pain level. Hematological parameters and serum levels of PSA, alkaline phosphatase, and lactate dehydrogenase were assessed prior to and at 4-week intervals after treatment. Results: Median survival of all patients was 7 months (95% CI: 6–9 months). Overall, 33/60 (55%) patients reported a decrease in pain after the first radionuclide treatment. This percentage was similar for patients treated with Re168-HEDP and Sr89. Mean duration of reported pain response was 75 days (± 68 days) for Sr89 and 61 days (± 56 days) for Re186-HEDP, which was not significantly different. A lower blood hemoglobin concentration was associated with a lower pain response rate. In a multivariate Cox regression analysis, pain response to radionuclide treatment predicted longer survival after treatment. Conclusions: Pain response was present in 55% of patients. Serum hemoglobin concentration prior to radionuclide treatment predicted pain response for both Re186-HEDP and Sr89. A reduction in pain upon radionuclide treatment was associated with a longer survival after treatment.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 66%

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Serum Hemoglobin Levels Predict Response to Strontium-89 and Rhenium-186-HEDP Radionuclide Treatment for Painful Osseous Metastases in Prostate Cancer

Poel

Antonini²,

Hoefnagel³

et al. 2006

Urol Int

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“…Therefore, Sr-89 therapy is considered to exert a positive effect against pain, even when the bone metastasis is not extensive. However, a pain relief effect may also be obtained in patients with extensive bone metastasis, although it is difficult to precisely predict the effect prior to Sr-89 administration (18). These reports support the present findings.…”

Section: Discussionsupporting

confidence: 79%

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

Furubayashi

Negishi

Ura

et al. 2014

Molecular and Clinical Oncology

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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.

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“…Several studies indicated that Sr-89 was effective in patients when administered in the early stage as an efficacy-predicting factor, whereas Sr-89 was less effective in the terminal stage and caused marked adverse effects (18)(19)(20)(21)(22). Therefore, when life expectancy is estimated to be extremely short (1 month or less), Sr-89 administration is not indicated.…”

Section: Discussionmentioning

confidence: 99%

Concurrent use of Sr-89 chloride with zoledronic acid is safe and effective for breast cancer patients with painful bone metastases

Yamada

Yoshimura

Kojima

et al. 2011

Experimental and Therapeutic Medicine

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Abstract. Our aim in this study was to examine the safety and efficacy of the concurrent use of the radiopharmaceutical strontium-89 (Sr-89) chloride with zoledronic acid in standard anticancer therapy for breast cancer patients with painful multifocal bone metastases. The study comprised 16 breast cancer patients with painful multifocal bone metastases detected by bone scintigraphy, computed tomography or magnetic resonance imaging. All patients were treated with Sr-89 and zoledronic acid concurrently between March 2007 and February 2011 as part of a standard therapeutic regimen comprising chemotherapy, endocrine therapy, molecular targeting therapy and targeted radiotherapy. Sr-89 was administered intravenously at 2 MBq/kg to a maximum of 141 MBq per person. Safety was evaluated according to myelotoxicity as measured by the Common Terminology Criteria for Adverse Events (v3.0). To assess treatment efficacy, we monitored changes in analgesic drug dosages. Furthermore, bremsstrahlung imaging after the administration of Sr-89 was utilized to examine the relationship between the accumulation of Sr-89 in metastatic sites and treatment efficacy. Based on the results, a total of 14 out of 16 patients (88%) reported bone pain relief, indicating a high efficacy of Sr-89 combined with zoledronic acid. In responsive cases, a strong uptake of Sr-89 was observed on bremsstrahlung imaging at the same sites indicated by 99m Tc bone scintigraphy. Moreover, severe myelosuppression (> grade 3) was not observed, and adverse events were tolerable. In conclusion, the use of Sr-89 with zoledronic acid in breast cancer patients with painful bone metastases was safe and effective when administered concurrently with other standard therapies. In the future, the treatment with Sr-89 at the early stage should be considered, and a large-scale clinical study should be conducted.

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Predictors of Response to Strontium-89 (Metastron®) in Skeletal Metastases from Prostate Cancer: Report of a Single Centre's 10-Year Experience

Cited by 18 publications

References 15 publications

Serum Hemoglobin Levels Predict Response to Strontium-89 and Rhenium-186-HEDP Radionuclide Treatment for Painful Osseous Metastases in Prostate Cancer

Serum Hemoglobin Levels Predict Response to Strontium-89 and Rhenium-186-HEDP Radionuclide Treatment for Painful Osseous Metastases in Prostate Cancer

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

Concurrent use of Sr-89 chloride with zoledronic acid is safe and effective for breast cancer patients with painful bone metastases

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