Targeted Palliative Radionuclide Therapy for Metastatic Bone Pain

Abstract

Bone metastasis develops in multiple malignancies with a wide range of incidence. The presence of multiple bone metastases, leading to a multitude of complications and poorer prognosis. The corresponding refractory bone pain is still a challenging issue managed through multidisciplinary approaches to enhance the quality of life. Radiopharmaceuticals are mainly used in the latest courses of the disease. Bone-pain palliation with easy-to-administer radionuclides offers advantages, including simultaneous treatment of multiple metastatic foci, the repeatability and also the combination with other therapies. Several β¯- and α-emitters as well as pharmaceuticals, from the very first [89Sr]strontium-dichloride to recently introduced [223Ra]radium-dichloride, are investigated to identify an optimum agent. In addition, the combination of bone-seeking radiopharmaceuticals with chemotherapy or radiotherapy has been employed to enhance the outcome. Radiopharmaceuticals demonstrate an acceptable response rate in pain relief. Nevertheless, survival benefits have been documented in only a limited number of studies. In this review, we provide an overview of bone-seeking radiopharmaceuticals used for bone-pain palliation, their effectiveness and toxicity, as well as the results of the combination with other therapies. Bone-pain palliation with radiopharmaceuticals has been employed for eight decades. However, there are still new aspects yet to be established.

A study on the preparation, evaluation of biological characteristics, and preliminary imaging of [188Re]Re-ibandronate

“…Numerous radiopharmaceuticals have been used to target and relieve bone pain since the introduction of radionuclides to treat bone pain in the 1940s [19]. [6,9].…”

“…However, each radiopharmaceutical has its own advantages and disadvantages. The choice is extremely dependent on the patient's status, such as the renal function and bone marrow reserve, cancer extent (extraskeletal lesions and the bulk of the tumor), and physical properties of radionuclides [19]. As the commercial availability of radiopharmaceuticals is limited, the availability of each radiopharmaceutical also needs to be considered.…”

Efficacy and Safety of Bone-Targeting Radioisotopes in Patients with Bone Metastases: A Meta-Analysis

“…The primary aim of the treatment of bone metastases was to prevent disease progression and relieve symptom [8]. It warranted a multidisciplinary approach including analgesics, bisphosphonates, chemotherapy, external beam radiotherapy (EBRT), immunological therapies, surgical operation, endocrine therapy, and bone-targeted radionuclide therapy [9][10][11]. Therapeutic strategies for patients with bone metastases is based on the property of the primary cancers, whether extraosseous metastases is present or not and whether the bone disease is local or extensive [8].…”

“…Furthermore, radionuclide targeted therapy not only relieves pain in patients, but also it decreases or delays the occurrence of skeletal-related events (SREs) [10]. βemitter radionucleotides, such as Strontium-89 and Samarium-153, have long been used to relieve bone pain and have shown their effectiveness in alleviating bone pain, unfortunately they caused severe bone marrow toxicity [11,18]. Radium-223 (an αemitter) dichloride is located in osseous tissue and forms a complex with hydroxyapatite on the theoretical basis that it's similar to calcium.…”

Special Issue: Emerging Technologies for Medical Imaging Diagnostics, Monitoring and Therapy of Cancers

“…In alignment with the individualized treatment approaches, Manafi-Farid et al [ 4 ] provided an overview of bone-seeking radiopharmaceuticals used for bone-pain palliation, and their effectiveness and toxicity, as well as the results of the combination with other therapies. In the setting of personalized medicine, the authors proposed an algorithm for the selection of an appropriate radiopharmaceutical for bone-pain palliation therapy.…”