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Murray I, Du Y. Systemic Radiotherapy of Bone Metastases With Radionuclides. Clin Oncol (R Coll Radiol) 2020; 33:98-105. [PMID: 33353771 DOI: 10.1016/j.clon.2020.11.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/23/2020] [Accepted: 11/30/2020] [Indexed: 11/30/2022]
Abstract
Treatments of bone metastases using radionuclides are now well established in oncology. It is also a field that continues to develop. This article reviews the evidence base that led to the approval of strontium-89 and samarium-153 ethylenediaminetetramethylene phophanate (EDTMP) for the palliation of pain from bone metastases, as well as the evidence for the use of radium-223 in metastatic castrate-resistant prostate cancer. Efforts to optimise treatments and improve response rates, either by safely increasing the radiation dose to bone metastases or by combining treatment with non-radiation-based therapies, are discussed. In addition, the development of both alpha- and beta-particle-emitting radiopharmaceuticals designed to target prostate-specific membrane antigen are reviewed.
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Affiliation(s)
- I Murray
- Joint Department of Physics, The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Sutton, Surrey, UK.
| | - Y Du
- Nuclear Medicine Department, The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
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Badrising SK, Louhanepessy RD, van der Noort V, Coenen JLLM, Hamberg P, Beeker A, Wagenaar N, Lam MGEH, Celik F, Loosveld OJL, Oostdijk A, Zuetenhorst H, Haanen JB, Vegt E, Zwart W, Bergman AM. A prospective observational registry evaluating clinical outcomes of Radium-223 treatment in a nonstudy population. Int J Cancer 2020; 147:1143-1151. [PMID: 31875956 PMCID: PMC7383569 DOI: 10.1002/ijc.32851] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 11/18/2019] [Accepted: 11/28/2019] [Indexed: 11/07/2022]
Abstract
The ALSYMPCA study established a 3.6 month Overall Survival (OS) benefit in metastatic Castration Resistant Prostate Cancer (mCRPC) patients treated with Radium-223 dichloride (Ra-223) over placebo. Here we report clinical outcomes of Ra-223 treatment in a nonstudy population. In this prospective registry, patients from 20 Dutch hospitals were included prior to Ra-223 treatment. Clinical parameters collected included previous treatments and Adverse Events. Primary outcome was 6 months Symptomatic Skeletal Event (SSE)-free survival, while secondary outcomes included Progression-Free Survival (PFS) and Overall Survival (OS). Of the 305 patients included, 300 were evaluable. The mean age was 73.6 years, 90% had ≥6 bone metastases and 74.1% were pretreated with Docetaxel, 19.5% with Cabazitaxel and 80.5% with Abiraterone and/or Enzalutamide. Of all patients, 96.7% were treated with Ra-223 and received a median of 5 cycles. After a median follow-up of 13.2 months, 6 months SSE-free survival rate was 83%, median PFS was 5.1 months and median OS was 15.2 months. Six months SSE-free survival rate and OS were comparable with those reported in ALSYMPCA. "Previous Cabazitaxel treatment" and "bone-only metastases" were independent predictors of a shorter and longer PFS, respectively, while above-median LDH and "bone-only metastases" were independent predictors of shorter and longer OS, respectively. Toxicity was similar as reported in the ALSYMPCA trial. These results suggest that in a nonstudy population, Ra-223 treatment is well-tolerated, equally effective as in the ALSYMPCA population and that patients not previously treated with Cabazitaxel benefit most from Ra-223.
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Affiliation(s)
- Sushil K Badrising
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Rebecca D Louhanepessy
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | | | - Paul Hamberg
- Department of Medical Oncology, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Aart Beeker
- Department of Medical Oncology, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - Nils Wagenaar
- Department of Nuclear Medicine, Ziekenhuisgroep Twente, Hengelo, The Netherlands
| | - Marnix G E H Lam
- Department of Nuclear Medicine, UMC Utrecht, Utrecht, The Netherlands
| | - Filiz Celik
- Department of Nuclear Medicine, Deventer Hospital, Deventer, The Netherlands
| | - Olaf J L Loosveld
- Department or Medical Oncology, Amphia Hospital, Breda, The Netherlands
| | - Ad Oostdijk
- Department of Nuclear Medicine, Isala, Zwolle, The Netherlands
| | - Hanneke Zuetenhorst
- Department of Medical Oncology, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - John B Haanen
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Erik Vegt
- Department of Nuclear Medicine, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Wilbert Zwart
- Division of Oncogenomics, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Andries M Bergman
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Division of Oncogenomics, Netherlands Cancer Institute, Amsterdam, The Netherlands
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Shi C, Wu T, He Y, Zhang Y, Fu D. Recent advances in bone-targeted therapy. Pharmacol Ther 2020; 207:107473. [PMID: 31926198 DOI: 10.1016/j.pharmthera.2020.107473] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 01/06/2020] [Indexed: 02/07/2023]
Abstract
The coordination between bone resorption and bone formation plays an essential role in keeping the mass and microstructure integrity of the bone in a steady state. However, this balance can be disturbed in many pathological conditions of the bone. Nowadays, the classical modalities for treating bone-related disorders are being challenged by severe obstacles owing to low tissue selectivity and considerable safety concerns. Moreover, as a highly mineralized tissue, the bone shows innate rigidity, low permeability, and reduced blood flow, features that further hinder the effective treatment of bone diseases. With the development of bone biology and precision medicine, one novel concept of bone-targeted therapy appears to be promising, with improved therapeutic efficacy and minimized systematic toxicity. Here we focus on the recent advances in bone-targeted treatment based on the unique biology of bone tissues. We summarize commonly used bone-targeting moieties, with an emphasis on bisphosphonates, tetracyclines, and biomimetic bone-targeting moieties. We also introduce potential bone-targeting strategies aimed at the bone matrix and major cell types in the bone. Based on these bone-targeting moieties and strategies, we discuss the potential applications of targeted therapy to treat bone diseases. We expect that this review will put together useful insights to help with the search for therapeutic efficacy in bone-related conditions.
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Affiliation(s)
- Chen Shi
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology (HUST), Wuhan, PR China
| | - Tingting Wu
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology (HUST), Wuhan, PR China
| | - Yu He
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology (HUST), Wuhan, PR China
| | - Yu Zhang
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology (HUST), Wuhan, PR China
| | - Dehao Fu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology (HUST), Wuhan, PR China.
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Zustovich F, Barsanti R. Targeted α Therapies for the Treatment of Bone Metastases. Int J Mol Sci 2017; 19:ijms19010074. [PMID: 29283383 PMCID: PMC5796024 DOI: 10.3390/ijms19010074] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 11/27/2017] [Accepted: 12/06/2017] [Indexed: 11/23/2022] Open
Abstract
The skeleton is the target tissue for many types of tumors, and, recently, the survival of patients with prostate cancer metastasis has been increased using α-emitting drugs known as targeted α therapies. The use of α-radiopharmaceuticals in medicine was hypothesized at the beginning of the nineteenth century after the observation that α-radionuclides were associated with high cell-killing energy and low tissue penetration in healthy tissues. In the prostate cancer (PC) scenario, current research suggests that this class of radiopharmaceuticals has limited toxicity, and that the mechanism of action does not overlap with pre-existing drugs, allowing us to extend therapeutic armaments and address medical oncology towards personalized and precision medicine. Ongoing studies may extend these benefits also to bone metastases deriving from other neoplasms. The aim of this review is to summarize the current research on targeted α therapies and try to identify the right patient to be treated in the right time in order to integrate in these medications in the every-day clinical practice.
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Affiliation(s)
- Fable Zustovich
- UOC Oncologia, ULSS 1 Dolomiti, Belluno Medical Hospital "San Martino", Viale Europa 22, 32100 Belluno, Italy.
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Carles J, Méndez MJ, Pinto Á, Sáez MI, Arranz JA, Maroto P, López-Criado P, Mellado B, Donas JG, Hernando S, León L, Del Alba AG, Laínez N, Esteban E, Reynés G, Pérez-Gracia JL, Germà JR, López-Brea M, Pérez-Valderrama B, Moretones C, Castellano D. Radium-223 international early access program: results from the Spanish subset. Future Oncol 2017; 14:41-50. [PMID: 29232987 DOI: 10.2217/fon-2017-0297] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM To report results from the Spanish subset included in the radium-223 international early access program (iEAP). PATIENTS & METHODS Ninety patients with castration-resistant prostate cancer and bone metastases received radium-223 55 kBq/kg every 4 weeks for six cycles. RESULTS The median time to disease progression was 8 months and to prostate-specific antigen progression was 4 months. The percentage of patients with ≥50% confirmed declines in prostate-specific antigen was 9%. The median overall survival was 14 months. Grade 3 or 4 treatment emergent adverse events (TEAEs) occurred in 34% of patients (serious TEAEs 28%, TEAEs leading to discontinuation 27%). CONCLUSION Outcomes of the Spanish subset are consistent with the iEAP. Radium-223 was generally well tolerated with no safety concerns.
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Affiliation(s)
- Joan Carles
- Department of Medical Oncology, Hospital Universitario Vall d'Hebrón, Vall d'Hebron Institute of Oncology, 08035 Barcelona, Spain
| | - Mª José Méndez
- Department of Medical Oncology, Maimonides Institute of Biomedical Research (IMIBIC), Reina Sofía Hospital, University of Córdoba, 14004 Córdoba, Spain
| | - Álvaro Pinto
- Department of Medical Oncology, Hospital Universitario la Paz, 28046 Madrid, Spain
| | - Mª Isabel Sáez
- Department of Medical Oncology, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain
| | - José A Arranz
- Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
| | - Pablo Maroto
- Department of Medical Oncology, Hospital de la Santa Cruz y San Pablo, 08041 Barcelona, Spain
| | - Pilar López-Criado
- Department of Medical Oncology, MD Anderson Cancer Center, 28033 Madrid, Spain
| | - Begoña Mellado
- Department of Medical Oncology, Hospital Clínico y Provincial, 08036 Barcelona, Spain
| | | | - Susana Hernando
- Department of Medical Oncology, Hospital Universitario Fundación Alcorcón, 28922 Madrid, Spain
| | - Luís León
- Department of Medical Oncology, Complejo Hospitalario Universitario de Santiago, 15706 Santiago de Compostela, Spain
| | | | - Núria Laínez
- Department of Medical Oncology, Complejo Hospitalario de Navarra, 31008 Pamplona, Spain
| | - Emilio Esteban
- Department of Medical Oncology, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
| | - Gaspar Reynés
- Department of Medical Oncology, Hospital Universitario y Politécnico la Fe, 46026 Valencia, Spain
| | - José L Pérez-Gracia
- Department of Medical Oncology, Clínica Universidad de Navarra, 31008 Pamplona, Spain
| | - Josep R Germà
- Department of Medical Oncology, Instituto Catalán de Oncología, 08908 Hospitalet de Llobregat, Spain
| | - Marta López-Brea
- Department of Medical Oncology, Hospital Universitario Marqués de Valdecilla, 39008 Santander, Spain
| | - Begoña Pérez-Valderrama
- Department of Medical Oncology, Hospital Universitario Virgen del Rocío, 41013 Sevilla, Spain
| | | | - Daniel Castellano
- Department of Medical Oncology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain
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SEOM clinical guidelines for the treatment of metastatic prostate cancer (2017). Clin Transl Oncol 2017; 20:57-68. [PMID: 29134562 PMCID: PMC5785604 DOI: 10.1007/s12094-017-1783-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 10/19/2017] [Indexed: 02/08/2023]
Abstract
Androgen deprivation treatment was the only treatment available for metastatic prostate cancer until recently, with docetaxel as the only treatment with a proven survival benefit in castration-resistant prostate cancer (CRPC). Several drugs have been approved in the castration-resistant disease (sipuleucel-T, cabazitaxel, abiraterone, enzalutamide, radium-223). More recently, docetaxel and abiraterone have been moved to the hormone-sensitive disease setting, achieving better patient survival. The purpose of this article is to define the state of the art in the treatment of prostate carcinoma.
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Radium-223 dichloride in clinical practice: a review. Eur J Nucl Med Mol Imaging 2016; 43:1896-909. [DOI: 10.1007/s00259-016-3386-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 03/29/2016] [Indexed: 02/06/2023]
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