Strontium-89 chloride for pain palliation in prostatic skeletal malignancy

Laing, A. H.; Ackery, D. M.; Bayly, R. J.; Buchanan, R. B.; Lewington, Val; McEwan, Alexander; MacLeod, P.; Zivanovic, Maureen A.

doi:10.1259/0007-1285-64-765-816

Cited by 194 publications

(87 citation statements)

References 17 publications

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“…Whilst the confidence intervals are wide, the plots reveal that good prognosis patients (better ECOG, low baseline PSA and low bone scan load) tend to demonstrate larger increase in QoL score. This observation is in keeping with Laing et al (1991) who reported that a better analgesic effect was achieved with the administration of Sr-89 whilst skeletal disease load was relatively low. The trend for preferential benefit for good prognostic factors continued into the second period.…”

Section: Discussionsupporting

confidence: 90%

“…The response rates to Sr-89 therapy of 62.5% (including 17.5% complete responses) in this group of patients were typical of those reported in phase III Porter et al, 1993a;Quilty et al, 1994) and large phase II studies (Robinson et al, 1989;Laing et al, 1991) in the literature. This is despite the relative 'late' use of this agent in this study as judged by the high median baseline PSA (96 ng ml -1 ), high proportion of patients with extensive skeletal disease (63% of 92 evaluable patients had more than 20 bone scan hot spots).…”

Section: Discussionsupporting

confidence: 79%

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Less pain does equal better quality of life following strontium-89 therapy for metastatic prostate cancer

et al. 2001

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Several phase III studies (Quilty et al, 1982;Lewington et al, 1991;McEwan et al, 1994;Malmberg et al, 1997) now support the usefulness and cost effectiveness of Sr-89 either as an alternative or an adjunct to external beam radiotherapy (EBRT) in men with bone pain due to metastatic prostate cancer. Primary study end points have included pain response presented in terms of reduction in severity and/or frequency of pain and/or analgesic use, delayed onset of new painful sites and/or decrease in EBRT requirement over the patient's remaining lifetime.It is recognized that the effects of palliative treatment extend beyond simply reducing the severity of a reference symptom, such as pain. Health-related QoL describes a multidimensional view of a patient's psychological and social, as well as physical wellbeing. Despite the frequent citing of the importance of overall QoL in men with metastatic prostate cancer and the potential impact that Sr-89 might have on QoL, there has been little attention paid to formal evaluation of QoL as a primary end-point in the study of Sr-89 to date.The Trans Canada Study Group (Porter et al, 1993) undertook a limited QoL evaluation and found that in the areas of physical mobility and pain control, Sr-89 produced a significant beneficial effect for men with metastatic prostate cancer. This assessment, as the authors acknowledge, was not ideal in that a standardized instrument was not used and conclusions were based on data pooled from a number of non-validated instruments including linear analogue self assessment scales, questionnaires and patient diaries.Following the establishment of a Government reimbursement in early 1995, Sr-89 therapy for the relief of bone pain due to prostate cancer became widely available in Australia. A group of interested Radiation Oncologists (the Australian Metastron User's Group) took this opportunity to initiate a prospective study to (1) confirm that treatment efficacy and toxicity were consistent with the world literature and to (2) simultaneously assess the nature and time course of any possible QoL benefits using a validated instrument. Secondary end-points included toxicity, (specifically bone marrow depression, pain 'flare' and/or other unexpected morbidity), and PSA 'response' following Sr-89. MATERIALS AND METHODSThis was a prospective multicentre study involving 13 oncology centres in 5 states and territories of Australia. Accrual took place over a two-year period from mid 1995 to mid 1997. There was a minimum 8-month interval from the date of Sr-89 injection in the last study patient to analysis, with a median follow up overall of 6.8 months (censoring patients at death).Eligible patients were those who had histologically proven prostate cancer with bone scan evidence of metastatic disease and who had progressed either clinically, biochemically or both following 'standard' first-line hormone therapy (with or without further hormonal manoeuvres), and who had one or more sites of bony pain. 7 patients had previously been treated with various chemot...

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 79%

Less pain does equal better quality of life following strontium-89 therapy for metastatic prostate cancer

et al. 2001

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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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“…Approximately 15% of the patients experience increased pain or flares after 1-5 days, which may last for 4 days. A previous trial reported that pain flares were associated with a good response to Sr-89 (19); by contrast, a multicenter trial reported that such flares are not associated with the effect of Sr-89 treatment (20). Therefore, the clinical significance of pain flares remains unclear.…”

Section: Discussionmentioning

confidence: 99%

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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Strontium-89 chloride for pain palliation in prostatic skeletal malignancy

Cited by 194 publications

References 17 publications

Less pain does equal better quality of life following strontium-89 therapy for metastatic prostate cancer

Less pain does equal better quality of life following strontium-89 therapy for metastatic prostate cancer

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

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

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