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Cook GJR, Thorpe MP. Bone Metastases. Cancer J 2024; 30:202-209. [PMID: 38753755 DOI: 10.1097/ppo.0000000000000717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
ABSTRACT Bone metastases occur frequently in common malignancies such as breast and prostate cancer. They are responsible for considerable morbidity and skeletal-related events. Fortunately, there are now several systemic, focal, and targeted therapies that can improve quality and length of life, including radionuclide therapies. It is therefore important that bone metastases can be detected as early as possible and that treatment can be accurately and sensitively monitored. Several bone-specific and tumor-specific single-photon emission computed tomography and positron emission tomography molecular imaging agents are available, for detection and monitoring response to systemic therapeutics, as well as theranostic agents to confirm target expression and predict response to radionuclide therapies.
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Affiliation(s)
- Gary J R Cook
- From the Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas' Hospital, London, UK
| | - Matthew P Thorpe
- Division of Nuclear Radiology, Department of Radiology, Mayo Clinic, Rochester, MN
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2
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Rugo HS, Van Poznak CH, Neven P, Danielewicz I, Lee SC, Campone M, Chik JYK, Vega Alonso E, Naume B, Brain E, Siegel JM, Li R, Uema D, Wagner VJ, Coleman RE. Radium-223 in women with hormone receptor-positive bone-metastatic breast cancer receiving endocrine therapy: pooled analysis of two international, phase 2, randomized, double-blind, placebo-controlled trials. Breast Cancer Res Treat 2024; 204:249-259. [PMID: 38123789 PMCID: PMC10948526 DOI: 10.1007/s10549-023-07147-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 09/26/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Most women with advanced breast cancer have skeletal metastases. Radium-223 is an alpha-emitting radionuclide that selectively targets areas of bone metastases. METHODS Two double-blind, placebo-controlled studies of radium-223 were conducted in women with hormone receptor-positive (HR+), bone-predominant metastatic breast cancer. All patients received endocrine therapy (ET), as a single agent of the investigator's choice (Study A) or exemestane + everolimus (Study B). Patients were randomized to receive radium-223 (55 kBq/kg) or placebo intravenously every 4 weeks for six doses. Accrual was halted following unblinded interim analyses per protocol amendments, and both studies were terminated. We report pooled analyses of symptomatic skeletal event-free survival (SSE-FS; primary endpoint), radiologic progression-free survival (rPFS) and overall survival (OS; secondary), and time to bone alkaline phosphatase (ALP) progression (exploratory). RESULTS In total, 382 patients were enrolled, and 196 SSE-FS events (70% planned total) were recorded. Hazard ratios (95% confidence intervals) and nominal p values for radium-223 + ET versus placebo + ET were: SSE-FS 0.809 (0.610-1.072), p = 0.1389; rPFS 0.956 (0.759-1.205), p = 0.7039; OS 0.889 (0.660-1.199), p = 0.4410; and time to bone ALP progression 0.593 (0.379-0.926), p = 0.0195. Radium-223- or placebo-related treatment-emergent adverse events were reported in 50.3% versus 35.1% of patients (grade 3/4: 25.7% vs. 8.5%), with fractures/bone-associated events in 23.5% versus 23.9%. CONCLUSIONS In patients with HR+ bone-metastatic breast cancer, numeric differences favoring radium-223 + ET over placebo + ET for the primary SSE-FS endpoint were suggestive of efficacy, in line with the primary outcome measure used in the underlying phase 2 studies. No similar evidence of efficacy was observed for secondary progression or survival endpoints. Adverse events were more frequent with radium-223 + ET versus placebo + ET, but the safety profile of the combination was consistent with the safety profiles of the component drugs. Clinical trial registration numbers Study A: NCT02258464, registered October 7, 2014. Study B: NCT02258451, registered October 7, 2014.
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Affiliation(s)
- Hope S Rugo
- University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA.
- Department of Medicine (Hematology/Oncology), University of California San Francisco Helen Diller Family Comprehensive Cancer Center, 1825 4th St., 3rd Floor, San Francisco, CA, 94158, USA.
| | | | | | | | - Soo Chin Lee
- National University Hospital (S) Pte Ltd, Singapore, Singapore
| | - Mario Campone
- Institut de Cancerologie de l'Ouest, St Herblain, France
| | | | | | - Bjørn Naume
- Institute of Clinical Medicine, University of Oslo, and Oslo University Hospital, Oslo, Norway
| | - Etienne Brain
- Institut Curie - René-Huguenin Hospital, Saint-Cloud, France
| | | | - Rui Li
- Bayer HealthCare Pharmaceuticals Inc., Whippany, NJ, USA
| | - Deise Uema
- Bayer HealthCare Pharmaceuticals Inc., Whippany, NJ, USA
| | | | - Robert E Coleman
- Cancer Clinical Trials Centre, University of Sheffield, Weston Park Hospital, Sheffield, UK.
- Department of Oncology and Metabolism, Cancer Clinical Trials Centre, Weston Park Hospital, Broomcross Building, Floor 2, Whitham Road, Sheffield, S10 2SJ, UK.
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3
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Franchi S, Asti M, Di Marco V, Tosato M. The Curies' element: state of the art and perspectives on the use of radium in nuclear medicine. EJNMMI Radiopharm Chem 2023; 8:38. [PMID: 37947909 PMCID: PMC10638329 DOI: 10.1186/s41181-023-00220-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 10/19/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND The alpha-emitter radium-223 (223Ra) is presently used in nuclear medicine for the palliative treatment of bone metastases from castration-resistant prostate cancer. This application arises from its advantageous decay properties and its intrinsic ability to accumulate in regions of high bone turnover when injected as a simple chloride salt. The commercial availability of [223Ra]RaCl2 as a registered drug (Xofigo®) is a further additional asset. MAIN BODY The prospect of extending the utility of 223Ra to targeted α-therapy of non-osseous cancers has garnered significant interest. Different methods, such as the use of bifunctional chelators and nanoparticles, have been explored to incorporate 223Ra in proper carriers designed to precisely target tumor sites. Nevertheless, the search for a suitable scaffold remains an ongoing challenge, impeding the diffusion of 223Ra-based radiopharmaceuticals. CONCLUSION This review offers a comprehensive overview of the current role of radium radioisotopes in nuclear medicine, with a specific focus on 223Ra. It also critically examines the endeavors conducted so far to develop constructs capable of incorporating 223Ra into cancer-targeting drugs. Particular emphasis is given to the chemical aspects aimed at providing molecular scaffolds for the bifunctional chelator approach.
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Affiliation(s)
- Sara Franchi
- Department of Chemical Sciences, University of Padova, Via Marzolo 1, 35131, Padua, Italy
| | - Mattia Asti
- Radiopharmaceutical Chemistry Section, Nuclear Medicine Unit, AUSL di Reggio Emilia: Azienda Unità Sanitaria Locale - IRCCS Tecnologie Avanzate e Modelli Assistenziali in Oncologia di Reggio Emilia, Via Amendola 2, 42122, Reggio Emilia, Italy
| | - Valerio Di Marco
- Department of Chemical Sciences, University of Padova, Via Marzolo 1, 35131, Padua, Italy
| | - Marianna Tosato
- Radiopharmaceutical Chemistry Section, Nuclear Medicine Unit, AUSL di Reggio Emilia: Azienda Unità Sanitaria Locale - IRCCS Tecnologie Avanzate e Modelli Assistenziali in Oncologia di Reggio Emilia, Via Amendola 2, 42122, Reggio Emilia, Italy.
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4
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Karlsson J, Hagemann UB, Cruciani V, Schatz CA, Grant D, Ellingsen C, Kristian A, Katoozi S, Mihaylova D, Uran SR, Suominen M, Bjerke RM, Ryan OB, Cuthbertson A. Efficacy of a HER2-Targeted Thorium-227 Conjugate in a HER2-Positive Breast Cancer Bone Metastasis Model. Cancers (Basel) 2023; 15:3419. [PMID: 37444529 DOI: 10.3390/cancers15133419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/16/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
Human epidermal growth factor receptor 2 (HER2) is overexpressed in 15-30% of breast cancers but has low expression in normal tissue, making it attractive for targeted alpha therapy (TAT). HER2-positive breast cancer typically metastasizes to bone, resulting in incurable disease and significant morbidity and mortality. Therefore, new strategies for HER2-targeting therapy are needed. Here, we present the preclinical in vitro and in vivo characterization of the HER2-targeted thorium-227 conjugate (HER2-TTC) TAT in various HER2-positive cancer models. In vitro, HER2-TTC showed potent cytotoxicity in various HER2-expressing cancer cell lines and increased DNA double strand break formation and the induction of cell cycle arrest in BT-474 cells. In vivo, HER2-TTC demonstrated dose-dependent antitumor efficacy in subcutaneous xenograft models. Notably, HER2-TTC also inhibited intratibial tumor growth and tumor-induced abnormal bone formation in an intratibial BT-474 mouse model that mimics breast cancer metastasized to bone. Furthermore, a match in HER2 expression levels between primary breast tumor and matched bone metastases samples from breast cancer patients was observed. These results demonstrate proof-of-concept for TAT in the treatment of patients with HER2-positive breast cancer, including cases where the tumor has metastasized to bone.
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Affiliation(s)
- Jenny Karlsson
- Targeted Radiopharmaceuticals, Bayer AS, 0283 Oslo, Norway
| | | | | | | | - Derek Grant
- Targeted Radiopharmaceuticals, Bayer AS, 0283 Oslo, Norway
| | | | | | - Shirin Katoozi
- Targeted Radiopharmaceuticals, Bayer AS, 0283 Oslo, Norway
| | | | - Steinar R Uran
- Targeted Radiopharmaceuticals, Bayer AS, 0283 Oslo, Norway
| | | | - Roger M Bjerke
- Targeted Radiopharmaceuticals, Bayer AS, 0283 Oslo, Norway
| | - Olav B Ryan
- Targeted Radiopharmaceuticals, Bayer AS, 0283 Oslo, Norway
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Mou B, Cruz-Lim EM. Recurrent Extraneural Metastatic Medulloblastoma in an Adult Presenting With a Superscan and Treated With Radium-223. Cureus 2023; 15:e34732. [PMID: 36909024 PMCID: PMC9998111 DOI: 10.7759/cureus.34732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2023] [Indexed: 02/09/2023] Open
Abstract
A 32-year-old man with medulloblastoma was initially treated with subtotal resection and craniospinal irradiation. He developed recurrent metastatic disease three years later with extensive bone-only metastases. Biopsy of the bone lesions confirmed metastatic medulloblastoma and restaging investigations demonstrated a superscan with no evidence of recurrence in the craniospinal axis. Extraneural metastatic medulloblastoma is rare, and the presentation with diffuse bone-only metastases with a superscan on imaging is unique. The patient had diffusely painful bone metastases requiring multiple hospitalizations for poor pain control. He declined chemotherapy and was treated with radium-223, an alpha particle emitting radionuclide therapy typically used in metastatic castrate-resistant prostate cancer. The patient received three out of a planned six cycles of radium-223 before it was discontinued due to myelosuppression requiring multiple blood transfusions, and restaging demonstrated local recurrence in the posterior fossa. This is the first report to our knowledge describing the use of radium-223 in a patient with extraneural bone-only metastatic medulloblastoma. Further research into the effect of radium-223 in patients with diffuse bone-only metastases from non-prostate cancer primary tumors is warranted.
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Affiliation(s)
- Benjamin Mou
- Department of Radiation Oncology, BC Cancer, Kelowna, CAN
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6
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Bone Metastasis of Breast Cancer: Molecular Mechanisms and Therapeutic Strategies. Cancers (Basel) 2022; 14:cancers14235727. [PMID: 36497209 PMCID: PMC9738274 DOI: 10.3390/cancers14235727] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/07/2022] [Accepted: 11/17/2022] [Indexed: 11/24/2022] Open
Abstract
Bone metastasis is a common complication of many types of advanced cancer, including breast cancer. Bone metastasis may cause severe pain, fractures, and hypercalcemia, rendering clinical management challenging and substantially reducing the quality of life and overall survival (OS) time of breast cancer patients. Studies have revealed that bone metastasis is related to interactions between tumor cells and the bone microenvironment, and involves complex molecular biological mechanisms, including colonization, osteolytic destruction, and an immunosuppressive bone microenvironment. Agents inhibiting bone metastasis (such as bisphosphate and denosumab) alleviate bone destruction and improve the quality of life of breast cancer patients with bone metastasis. However, the prognosis of these patients remains poor, and the specific biological mechanism of bone metastasis is incompletely understood. Additional basic and clinical studies are urgently needed, to further explore the mechanism of bone metastasis and develop new therapeutic drugs. This review presents a summary of the molecular mechanisms and therapeutic strategies of bone metastasis of breast cancer, aiming to improve the quality of life and prognosis of breast cancer patients and provide a reference for future research directions.
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7
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Parlani M, Boccalatte F, Yeaton A, Wang F, Zhang J, Aifantis I, Dondossola E. 223Ra Induces Transient Functional Bone Marrow Toxicity. J Nucl Med 2022; 63:1544-1550. [PMID: 35177425 PMCID: PMC9536707 DOI: 10.2967/jnumed.121.263310] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 02/10/2022] [Indexed: 11/16/2022] Open
Abstract
223Ra is a bone-seeking, α-particle-emitting radionuclide approved for the treatment of patients with metastatic prostate cancer and is currently being tested in a variety of clinical trials for primary and metastatic cancers to bone. Clinical evaluation of 223Ra hematologic safety showed a significantly increased rate of neutropenia and thrombocytopenia in patients, hinting at myelosuppression as a side effect. Methods: In this study, we investigated the consequences of 223Ra treatment on bone marrow biology by combining flow cytometry, single-cell RNA sequencing, three-dimensional multiphoton microscopy and bone marrow transplantation analyses. Results: 223Ra accumulated in bones and induced zonal radiation damage confined to the bone interface, followed by replacement of the impaired areas with adipocyte infiltration, as monitored by 3-dimensional multiphoton microscopy ex vivo. Flow cytometry and single-cell transcriptomic analyses on bone marrow hematopoietic populations revealed transient, nonspecific 223Ra-mediated cytotoxicity on resident populations, including stem, progenitor, and mature leukocytes. This toxicity was paralleled by a significant decrease in white blood cells and platelets in peripheral blood-an effect that was overcome within 40 d after treatment. 223Ra exposure did not impair full hematopoietic reconstitution, suggesting that bone marrow function is not permanently hampered. Conclusion: Our results provide a comprehensive explanation of 223Ra reversible effects on bone marrow cells and exclude long-term myelotoxicity, supporting safety for patients.
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Affiliation(s)
- Maria Parlani
- Genitourinary Medical Oncology Department and David H. Koch Center for Applied Research of Genitourinary Cancers, University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Francesco Boccalatte
- Department of Pathology and Laura and Isaac Perlmutter Cancer Center, New York University School of Medicine, New York, New York; and
| | - Anna Yeaton
- Department of Pathology and Laura and Isaac Perlmutter Cancer Center, New York University School of Medicine, New York, New York; and
| | - Feng Wang
- Department of Genomic Medicine, University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Jianhua Zhang
- Department of Genomic Medicine, University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Iannis Aifantis
- Department of Pathology and Laura and Isaac Perlmutter Cancer Center, New York University School of Medicine, New York, New York; and
| | - Eleonora Dondossola
- Genitourinary Medical Oncology Department and David H. Koch Center for Applied Research of Genitourinary Cancers, University of Texas M.D. Anderson Cancer Center, Houston, Texas;
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8
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Houssiau H, Duhoux FP, François D, Seront E. Radium-223 as an Additional Therapeutic Strategy in Highly Selected Patients With Metastatic Breast Cancer: A Case Report. Front Oncol 2022; 12:896301. [PMID: 35712506 PMCID: PMC9195502 DOI: 10.3389/fonc.2022.896301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 04/25/2022] [Indexed: 11/22/2022] Open
Abstract
Radium-223 is commonly used in metastatic prostate cancer, targeting specifically bone metastases. The use of radium-223 remains, however, poorly evaluated in metastatic breast cancer. We report a case of radium-223 treatment in a 59-year-old patient with bone-only metastatic disease that progressed on multiple lines of systemic treatments. Radium-223 was very well tolerated and resulted in a regression of activity of bone metastases and in a 6-month progression-free survival. However, progression occurred in the liver, reflecting the fact that radium-223 should be combined with other systemic agents. This suggests that this therapeutic option is feasible and could be proposed in highly selected patients with bone metastatic disease outside of the prostate cancer field. Positron Emission Tomography appears also as a valuable tool for the evaluation of radium-223 efficacy.
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Affiliation(s)
- Hélène Houssiau
- Department of Medical Oncology, Centre Hospitalier de Jolimont, Haine Saint Paul, Belgium
| | - Francois P Duhoux
- Department of Medical Oncology, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - Didier François
- Department of Nuclear Medicine, Centre Hospitalier de Jolimont, Haine Saint Paul, Belgium
| | - Emmanuel Seront
- Department of Medical Oncology, Centre Hospitalier de Jolimont, Haine Saint Paul, Belgium
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9
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Duan H, Iagaru A, Aparici CM. Radiotheranostics - Precision Medicine in Nuclear Medicine and Molecular Imaging. Nanotheranostics 2022; 6:103-117. [PMID: 34976584 PMCID: PMC8671964 DOI: 10.7150/ntno.64141] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 08/09/2021] [Indexed: 02/07/2023] Open
Abstract
'See what you treat and treat what you see, at a molecular level', could be the motto of theranostics. The concept implies diagnosis (imaging) and treatment of cells (usually cancer) using the same molecule, thus guaranteeing a targeted cytotoxic approach of the imaged tumor cells while sparing healthy tissues. As the brilliant late Sam Gambhir would say, the imaging agent acts like a 'molecular spy' and reveals where the tumoral cells are located and the extent of disease burden (diagnosis). For treatment, the same 'molecular spy' docks to the same tumor cells, this time delivering cytotoxic doses of radiation (treatment). This duality represents the concept of a 'theranostic pair', which follows the scope and fundamental principles of targeted precision and personalized medicine. Although the term theranostic was noted in medical literature in the early 2000s, the principle is not at all new to nuclear medicine. The first example of theranostic dates back to 1941 when Dr. Saul Hertz first applied radioiodine for radionuclide treatment of thyroid cells in patients with hyperthyroidism. Ever since, theranostics has been an integral element of nuclear medicine and molecular imaging. The more we understand tumor biology and molecular pathology of carcinogenesis, including specific mutations and receptor expression profiles, the more specific these 'molecular spies' can be developed for diagnostic molecular imaging and subsequent radionuclide targeted therapy (radiotheranostics). The appropriate selection of the diagnostic and therapeutic radionuclide for the 'theranostic pair' is critical and takes into account not only the type of cytotoxic radiation emission, but also the linear energy transfer (LET), and the physical half-lives. Advances in radiochemistry and radiopharmacy with new radiolabeling techniques and chelators are revolutionizing the field. The landscape of cytotoxic systemic radionuclide treatments has dramatically expanded through the past decades thanks to all these advancements. This article discusses present and promising future theranostic applications for various types of diseases such as thyroid disorders, neuroendocrine tumors (NET), pediatric malignancies, and prostate cancer (PC), and provides an outlook for future perspectives.
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Affiliation(s)
| | | | - Carina Mari Aparici
- Department of Radiology, Division of Nuclear Medicine and Molecular Imaging, Stanford University, Stanford, CA, USA
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10
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Minekawa TB, Santos AO, Moraes AG, Sasse A, Silva CA, Lima MT, Camacho M, Lima MC, Etchebehere E. Single-center developing country analysis of radium-223 therapy in prostate cancer-preliminary results. AMERICAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING 2021; 11:352-362. [PMID: 34754606 PMCID: PMC8569335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 07/21/2021] [Indexed: 06/13/2023]
Abstract
We reviewed the records of mCRPC patients treated with off-label use of Ra-223. Ra-223 efficiency in this non-study population was correlated to outcome measures overall survival (OS), progression-free survival (PFS), bone event-free survival, bone marrow failure (BMF), and disease-related biomarkers. There were no limits regarding the number of prior hormonal agents or chemotherapy received before or during Ra-223. Exclusion criteria consisted of baseline platelet counts below 50,000/mm3 and/or absolute neutrophil counts below 1,500/mm3. Twenty-eight patients received 130 cycles of Ra-223 between 2017 and 2018. The overall median OS was 15.6 months. However, in patients submitted to 4 or fewer cycles, the median OS was 9.1 months; in contrast, the median OS was 18.5 months in patients submitted to 5 or 6 cycles. There was a significant inverse correlation between the number of cycles and the occurrence of bone events (76.2% of the patients that completed 6 cycles did not present bone events, while 71.4% of the patients that had skeletal-related events were submitted to less than 6 cycles). 82.1% of the patients were submitted to concomitant therapies with no significant side effects. There was also a decrease in ALP and LDH levels throughout treatment. Radium-223 increased OS and decreased bone events, especially when patients were able to complete 5-6 cycles. The proper selection of patients is crucial to improve outcomes.
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Affiliation(s)
- Thaís B Minekawa
- Division of Nuclear Medicine of The Department of Radiology, University of Campinas (UNICAMP)Campinas, Brazil
| | - Allan O Santos
- Division of Nuclear Medicine of The Department of Radiology, University of Campinas (UNICAMP)Campinas, Brazil
- Medicina Nuclear de Campinas (grupoMND)Campinas, Brazil
| | | | | | - Cleide A Silva
- Department of Statistics, University of Campinas (UNICAMP)Campinas, Brazil
| | - Marcelo T Lima
- Department of Statistics, University of Campinas (UNICAMP)Campinas, Brazil
| | | | - Mariana C Lima
- Division of Nuclear Medicine of The Department of Radiology, University of Campinas (UNICAMP)Campinas, Brazil
- Medicina Nuclear de Campinas (grupoMND)Campinas, Brazil
| | - Elba Etchebehere
- Division of Nuclear Medicine of The Department of Radiology, University of Campinas (UNICAMP)Campinas, Brazil
- Medicina Nuclear de Campinas (grupoMND)Campinas, Brazil
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11
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Bienia A, Wiecheć-Cudak O, Murzyn AA, Krzykawska-Serda M. Photodynamic Therapy and Hyperthermia in Combination Treatment-Neglected Forces in the Fight against Cancer. Pharmaceutics 2021; 13:1147. [PMID: 34452108 PMCID: PMC8399393 DOI: 10.3390/pharmaceutics13081147] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/26/2021] [Accepted: 07/16/2021] [Indexed: 12/24/2022] Open
Abstract
Cancer is one of the leading causes of death in humans. Despite the progress in cancer treatment, and an increase in the effectiveness of diagnostic methods, cancer is still highly lethal and very difficult to treat in many cases. Combination therapy, in the context of cancer treatment, seems to be a promising option that may allow minimizing treatment side effects and may have a significant impact on the cure. It may also increase the effectiveness of anti-cancer therapies. Moreover, combination treatment can significantly increase delivery of drugs to cancerous tissues. Photodynamic therapy and hyperthermia seem to be ideal examples that prove the effectiveness of combination therapy. These two kinds of therapy can kill cancer cells through different mechanisms and activate various signaling pathways. Both PDT and hyperthermia play significant roles in the perfusion of a tumor and the network of blood vessels wrapped around it. The main goal of combination therapy is to combine separate mechanisms of action that will make cancer cells more sensitive to a given therapeutic agent. Such an approach in treatment may contribute toward increasing its effectiveness, optimizing the cancer treatment process in the future.
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Affiliation(s)
| | | | | | - Martyna Krzykawska-Serda
- Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, 30-387 Kraków, Poland; (A.B.); (O.W.-C.); (A.A.M.)
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12
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Phelps TE, Roy J, Green MV, Seidel J, Baidoo KE, Adler S, Edmondson EF, Butcher D, Matta JL, Ton AT, Wong K, Huang S, Ren L, LeBlanc AK, Choyke PL, Jagoda EM. Sodium Fluoride-18 and Radium-223 Dichloride Uptake Colocalize in Osteoblastic Mouse Xenograft Tumors. Cancer Biother Radiopharm 2021; 36:133-142. [PMID: 33646017 DOI: 10.1089/cbr.2020.4068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: Patients with osteoblastic bone metastases are candidates for radium-223 (223RaCl2) therapy and may undergo sodium fluoride-18 (18F-NaF) positron emission tomography-computed tomography imaging to identify bone lesions. 18F-NaF has been shown to predict 223RaCl2 uptake, but intratumor distributions of these two agents remain unclear. In this study, the authors evaluate the spatial distribution and relative uptakes of 18F-NaF and 223RaCl2 in Hu09-H3 human osteosarcoma mouse xenograft tumors at macroscopic and microscopic levels to better quantify their correlation. Materials and Methods: 18F-NaF and 223RaCl2 were co-injected into Hu09-H3 xenograft tumor severe combined immunodeficient mice. Tumor content was determined from in vivo biodistributions and visualized by PET, single photon emission computed tomography, and CT imaging. Intratumor distributions were visualized by quantitative autoradiography of tumor tissue sections and compared to histology of the same or adjacent sections. Results: 18F and 223Ra accumulated in proportional amounts in whole Hu09-H3 tumors (r2 = 0.82) and in microcalcified regions within these tumors (r2 = 0.87). Intratumor distributions of 18F and 223Ra were spatially congruent in these microcalcified regions. Conclusions: 18F-NaF and 223RaCl2 uptake are strongly correlated in heterogeneously distributed microcalcified regions of Hu09-H3 xenograft tumors, and thus, tumor accumulation of 18F is predictive of 223Ra accumulation. Hu09-H3 xenograft tumors appear to possess certain histopathological features found in patients with metastatic bone disease and may be useful in clarifying the relationship between administered 223Ra dose and therapeutic effect.
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Affiliation(s)
- Tim E Phelps
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Jyoti Roy
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Michael V Green
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA.,Clinical Research Directorate, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Bethesda, Maryland, USA
| | - Jurgen Seidel
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA.,Clinical Research Directorate, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Bethesda, Maryland, USA
| | - Kwamena E Baidoo
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Stephen Adler
- Clinical Research Directorate, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Bethesda, Maryland, USA
| | - Elijah F Edmondson
- Molecular Histopathology Laboratory, Frederick National Laboratory for Cancer Research, NCI, Frederick, Maryland, USA
| | - Donna Butcher
- Molecular Histopathology Laboratory, Frederick National Laboratory for Cancer Research, NCI, Frederick, Maryland, USA
| | - Jennifer L Matta
- Molecular Histopathology Laboratory, Frederick National Laboratory for Cancer Research, NCI, Frederick, Maryland, USA
| | - Anita T Ton
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Karen Wong
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Shan Huang
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Ling Ren
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Amy K LeBlanc
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Peter L Choyke
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Elaine M Jagoda
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
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RADTHYR: an open-label, single-arm, prospective multicenter phase II trial of Radium-223 for the treatment of bone metastases from radioactive iodine refractory differentiated thyroid cancer. Eur J Nucl Med Mol Imaging 2021; 48:3238-3249. [PMID: 33619600 PMCID: PMC8426251 DOI: 10.1007/s00259-021-05229-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 02/01/2021] [Indexed: 01/02/2023]
Abstract
Purpose This is the first prospective trial evaluating the efficacy of alpha emitter Radium-223 in patients with bone metastases from radioactive iodine (RAI) refractory (RAIR) differentiated thyroid cancer. Methods RADTHYR is a multicenter, single-arm prospective Simon two-stage phase II trial (NCT02390934). The primary objective was to establish the efficacy of three administrations of 55 kBq/kg of Radium-223 by 18F-FDG PET/CT according to PERCIST criteria. Secondary objectives were to establish the efficacy of six administrations of Radium-223 by 18F-FDG PET/CT, 99mTc-HMDP bone scan and 18FNa PET/CT, clinical benefits, changes in serum bone markers, thyroglobulin levels, and safety. Results Ten patients were enrolled between July 2015 and December 2017 (4 M; median age 74 years). Prior to Radium-223 administration, patients received a median RAI cumulative activity of 15 GBq (7.4–35.6), external radiation therapy (n = 9), bone surgery (n = 8), cimentoplasty (n = 5), and cryoablation (n = 2). 18F-FDG PET/CT showed stable disease (SD) in 4/10 and progressive disease (PD) in 6/10 cases after three administrations and SD in 4/10, PD in 5/10 cases, and 1/10 non-evaluable (NE) case after six administrations. After six injections, 99mTc-HMDP bone scan showed SD in 9 cases and was NE in 1 case; 18FNa PET/CT showed SD in 8 cases, partial response (PR) in 1 case, and was NE in 1 case. No significant clinical benefits were reported during the study. A skeletal event occurred in 6 patients (median time without skeletal event of 12.1 months). Seventy-seven adverse events were reported during treatment (7 of grade 3–4). Three patients developed an acute myeloid, a promyelocytic, and a chronic myeloid leukemia after the last Radium-223 administration considered as drug-related. Conclusion The trial was stopped after interim analysis for lack of response of bone metastases from RAIR thyroid cancer to Radium-223. Severe hematological toxicity was observed in patients heavily pretreated with RAI and external radiation. Trial registration number NCT02390934. Registration date 18.03.2015. Supplementary Information The online version contains supplementary material available at 10.1007/s00259-021-05229-y.
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Costelloe CM, Lin PP, Chuang HH, Amini B, Chainitikun S, Yu TK, Ueno NT, Murphy WA, Madewell JE. Bone Metastases: Mechanisms of the Metastatic Process, Imaging and Therapy. Semin Ultrasound CT MR 2020; 42:164-183. [PMID: 33814103 DOI: 10.1053/j.sult.2020.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The mechanisms by which tumors metastasize to bone are complex. Upon the successful establishment of metastatic deposits in the skeleton, detection of the disease becomes essential for therapeutic planning. The roles of CT, skeletal scintigraphy, SPECT/CT, MRI, PET/CT and PET/MRI will be reviewed. Therapeutic response criteria specifically designed to evaluate bone metastases (MD Anderson/MDA criteria) can guide image interpretation. Knowledge of therapeutic strategies such as systemic therapy with bisphosphonates or radiopharmaceuticals, radiation therapy, surgery, and percutaneous interventions such as vertebroplasty and radiofrequency ablation can help the radiologist produce reports that will provide maximum benefit to clinicians and patients.
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Affiliation(s)
- Colleen M Costelloe
- Department of Musculoskeletal Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Patrick P Lin
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Hubert H Chuang
- Department of Nuclear Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Behrang Amini
- Department of Musculoskeletal Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sudpreeda Chainitikun
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Tse-Kuan Yu
- Radiation Oncology, Houston Precision Cancer Center, Houston, TX
| | - Naoto T Ueno
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - William A Murphy
- Department of Musculoskeletal Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - John E Madewell
- Department of Musculoskeletal Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
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15
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Targeted Palliative Radionuclide Therapy for Metastatic Bone Pain. J Clin Med 2020; 9:jcm9082622. [PMID: 32806765 PMCID: PMC7464823 DOI: 10.3390/jcm9082622] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 07/22/2020] [Accepted: 07/31/2020] [Indexed: 12/13/2022] Open
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.
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16
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Ueno NT, Tahara RK, Fujii T, Reuben JM, Gao H, Saigal B, Lucci A, Iwase T, Ibrahim NK, Damodaran S, Shen Y, Liu DD, Hortobagyi GN, Tripathy D, Lim B, Chasen BA. Phase II study of Radium-223 dichloride combined with hormonal therapy for hormone receptor-positive, bone-dominant metastatic breast cancer. Cancer Med 2019; 9:1025-1032. [PMID: 31849202 PMCID: PMC6997080 DOI: 10.1002/cam4.2780] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 11/22/2019] [Accepted: 12/02/2019] [Indexed: 12/20/2022] Open
Abstract
Background Radium‐223 dichloride (Ra‐223) is a targeted alpha therapy that induces localized cytotoxicity in bone metastases. We evaluated the efficacy and safety of Ra‐223 plus hormonal therapy in hormone receptor‐positive (HR+), bone‐dominant metastatic breast cancer. Methods In this single‐center phase II study, 36 patients received Ra‐223 (55 kBq/kg intravenously every 4 weeks) up to 6 cycles with endocrine therapy. The primary objective was to determine the clinical disease control rate at 9 months. Secondary objectives were to determine (a) tumor response rate at 6 months, (b) progression‐free survival (PFS) durations, and (c) safety. Results The median number of prior systemic treatments for metastatic disease was 1 (range, 0‐4). The disease control rate at 9 months was 49%. The tumor response rate at 6 months was 54% (complete response, 21%; partial, 32%). The median PFS was 7.4 months (95% CI, 4.8‐not reached [NR]). The median bone‐PFS was 16 months (95% CI, 7.3‐NR). There were no grade 3/4 adverse events. Conclusions Ra‐223 with hormonal therapy showed possible efficacy in HR+ bone‐dominant breast cancer metastasis, and adverse events were tolerable. We plan to further investigate the clinical application of Ra‐223 in these patients. (NCT02366130).
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Affiliation(s)
- Naoto T Ueno
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rie K Tahara
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Takeo Fujii
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - James M Reuben
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hui Gao
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Babita Saigal
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anthony Lucci
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Toshiaki Iwase
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nuhad K Ibrahim
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Senthil Damodaran
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yu Shen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Diane D Liu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gabriel N Hortobagyi
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Debu Tripathy
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bora Lim
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Beth A Chasen
- Department of Nuclear Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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