1
|
Naseri F, Charkhi A, Salek N, Vosoughi S. The radio-europium impurities in [153Sm]-EDTMP production: a review of isolation methods. Nucl Med Commun 2021; 42:951-963. [PMID: 34001824 DOI: 10.1097/mnm.0000000000001419] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Many human cancers predominantly metastasize to the bone which causes bone pain and other symptoms. However, the management of bone metastases is challenging. Radionuclide therapy using low-energy beta-emitting radionuclides has yielded encouraging results. The aim of this therapy is to deliver the maximum dose to the metastatic sites but a minimal dose to the normal tissue. Samarium-153 [153Sm]Sm-Ethylenediamine tetramethylene phosphonate (EDTMP) is an FDA and European Medicine Agency approved (Quadramet) radionuclide and is widely used for bone pain palliation. 153Sm is reactor produced, and the presence of europium impurities is thus unavoidable. This in turn causes an increase in the hospital radioactive waste burden and in radiation absorbed doses to the patients, and therefore it is a concern. The effective removal of these impurities is thus highly desirable before its administration to the patients. In this article, we present a detailed review of the various methods described in the literature for separation of 153Sm and Eu, that is solvent extraction, ion-exchange chromatography, electrochromatography, electrochemical separation and supported ionic liquid phase.
Collapse
Affiliation(s)
| | | | | | - Sara Vosoughi
- Radiation Application Research School, Nuclear Science and Technology Research Institute (NSTRI), Tehran, Iran
| |
Collapse
|
2
|
Sierko E, Hempel D, Zuzda K, Wojtukiewicz MZ. Personalized Radiation Therapy in Cancer Pain Management. Cancers (Basel) 2019; 11:cancers11030390. [PMID: 30893954 PMCID: PMC6468391 DOI: 10.3390/cancers11030390] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 03/05/2019] [Accepted: 03/11/2019] [Indexed: 12/11/2022] Open
Abstract
The majority of advanced cancer patients suffer from pain, which severely deteriorates their quality of life. Apart from analgesics, bisphosphonates, and invasive methods of analgesic treatment (e.g., intraspinal and epidural analgesics or neurolytic blockades), radiation therapy plays an important role in pain alleviation. It is delivered to a growing primary tumour, lymph nodes, or distant metastatic sites, producing pain of various intensity. Currently, different regiments of radiation therapy methods and techniques and various radiation dose fractionations are incorporated into the clinical practice. These include palliative radiation therapy, conventional external beam radiation therapy, as well as modern techniques of intensity modulated radiation therapy, volumetrically modulated arch therapy, stereotactic radiosurgery or stereotactic body radiation therapy, and brachytherapy or radionuclide treatment (e.g., radium-223, strontium-89 for multiple painful osseous metastases). The review describes the possibilities and effectiveness of individual patient-tailored conventional and innovative radiation therapy approaches aiming at pain relief in cancer patients.
Collapse
Affiliation(s)
- Ewa Sierko
- Department of Oncology, Medical University of Bialystok, 15-027 Białystok, Poland.
- Department of Radiation Therapy, Comprehensive Cancer Center of Białystok, 15-027 Bialystok, Poland.
| | - Dominika Hempel
- Department of Oncology, Medical University of Bialystok, 15-027 Białystok, Poland.
- Department of Radiation Therapy, Comprehensive Cancer Center of Białystok, 15-027 Bialystok, Poland.
| | - Konrad Zuzda
- Student Scientific Association Affiliated with Department of Oncology, Medical University of Bialystok, 15-027 Bialystok, Poland.
| | - Marek Z Wojtukiewicz
- Department of Oncology, Medical University of Bialystok, 15-027 Białystok, Poland.
| |
Collapse
|
3
|
Dash A, Das T, Knapp FFR. Targeted Radionuclide Therapy of Painful Bone Metastases: Past Developments, Current Status, Recent Advances and Future Directions. Curr Med Chem 2019; 27:3187-3249. [PMID: 30714520 DOI: 10.2174/0929867326666190201142814] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 10/29/2018] [Accepted: 12/06/2018] [Indexed: 12/13/2022]
Abstract
Bone pain arising from secondary skeletal malignancy constitutes one of the most common types of chronic pain among patients with cancer which can lead to rapid deterioration of the quality of life. Radionuclide therapy using bone-seeking radiopharmaceuticals based on the concept of localization of the agent at bone metastases sites to deliver focal cytotoxic levels of radiation emerged as an effective treatment modality for the palliation of symptomatic bone metastases. Bone-seeking radiopharmaceuticals not only provide palliative benefit but also improve clinical outcomes in terms of overall and progression-free survival. There is a steadily expanding list of therapeutic radionuclides which are used or can potentially be used in either ionic form or in combination with carrier molecules for the management of bone metastases. This article offers a narrative review of the armamentarium of bone-targeting radiopharmaceuticals based on currently approved investigational and potentially useful radionuclides and examines their efficacy for the treatment of painful skeletal metastases. In addition, the article also highlights the processes, opportunities, and challenges involved in the development of bone-seeking radiopharmaceuticals. Radium-223 is the first agent in this class to show an overall survival advantage in Castration-Resistant Prostate Cancer (CRPC) patients with bone metastases. This review summarizes recent advances, current clinical practice using radiopharmaceuticals for bone pain palliation, and the expected future prospects in this field.
Collapse
Affiliation(s)
- Ashutosh Dash
- Radiopharmaceuticals Division, Bhabha Atomic Research Centre, Trombay, Mumbai 400085, India.,Homi Bhabha National Institute, Anushaktinagar, Mumbai 400094, India
| | - Tapas Das
- Radiopharmaceuticals Division, Bhabha Atomic Research Centre, Trombay, Mumbai 400085, India.,Homi Bhabha National Institute, Anushaktinagar, Mumbai 400094, India
| | - Furn F Russ Knapp
- Medical Isotopes Program, Isotope Development Group, MS 6229, Bldg. 4501, Oak Ridge National Laboratory, PO Box 2008, 1 Bethel Valley Road, Oak Ridge, TN 37831, United States
| |
Collapse
|
4
|
Abstract
Two different molecular radio-theragnostic principles are applied in prostate cancer, providing a personalised management for those patients. Firstly, radiopharmaceuticals with the same or similar mechanism of action but different energy (gamma-γ, eg 99mTc-diphosphonates or positron-β+, eg 18F-NaF emitting isotopes) can be used to identify patients with osteoblastic metastases for a treatment with bone seeking beta (β-) or alpha (α-) emitting radionuclides to deliver targeted molecular radiotherapy. A number of such β- emitting molecules have been used for bone palliation. More recently, an alpha emitting 223Ra-dicholoride demonstrated not only symptomatic relief but also significantly improved overall survival in castration-resistant prostate cancer with predominant bone metastases. The second principle involves utilisation of the same prostatic specific membrane antigen (PSMA) or similar compound (eg PSMA-11, PSMA-617), but different label with either β+ (68Ga) or γ (99mTc) emitting radioisotope for imaging and subsequently β- (177Lu) or α (225Ac) emitting radionuclide for treatment.
Collapse
Affiliation(s)
- Yong Du
- Royal Marsden NHS Foundation Trust, London, UK
| | - Sabina Dizdarevic
- Brighton and Sussex University Hospitals NHS Trust and honorary reader and BSMS PET-CT lead, Brighton and Sussex Medical School, Brighton, UK
| |
Collapse
|
5
|
Ogawa K. Biocomplexes in radiochemistry. PHYSICAL SCIENCES REVIEWS 2016. [DOI: 10.1515/psr-2016-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
6
|
Well-designed bone-seeking radiolabeled compounds for diagnosis and therapy of bone metastases. BIOMED RESEARCH INTERNATIONAL 2015; 2015:676053. [PMID: 26075256 PMCID: PMC4446473 DOI: 10.1155/2015/676053] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 10/04/2014] [Accepted: 10/08/2014] [Indexed: 11/18/2022]
Abstract
Bone-seeking radiopharmaceuticals are frequently used as diagnostic agents in nuclear medicine, because they can detect bone disorders before anatomical changes occur. Furthermore, their effectiveness in the palliation of metastatic bone cancer pain has been demonstrated in the clinical setting. With the aim of developing superior bone-seeking radiopharmaceuticals, many compounds have been designed, prepared, and evaluated. Here, several well-designed bone-seeking compounds used for diagnostic and therapeutic use, having the concept of radiometal complexes conjugated to carrier molecules to bone, are reviewed.
Collapse
|
7
|
Borsò E, Boni G, Galli L, Ricci S, Farnesi A, Mazzarri S, Cianci C, Mariani G, Falcone A. Radium 223 dichloride: a multidisciplinary approach to metastatic castration-resistant prostate cancer. Future Oncol 2015; 11:323-31. [DOI: 10.2217/fon.14.157] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
ABSTRACT The role of nuclear medicine physicians in the multidisciplinary team for the management of patients with prostate cancer has been restricted because of a lack of available tools. The only drugs approved to relieve pain related to bone metastases were β-emitting radiopharmaceuticals. These drugs did not prove to prolong survival when used as single agent and resulted associated with important adverse events. This situation has changed with the introduction of radium 223 because of evidence of improved survival in patients, the good safety profile and the opportunity to avoid clonal selection of tumor cells. Cooperation among physicians involved in cancer management will lead to improvements in the treatment of bone metastases due to prostate cancer and is thought to extend to other tumor types.
Collapse
Affiliation(s)
- Elisa Borsò
- Division of Nuclear Medicine, University Hospital of Pisa, Pisa, Italy
| | - Giuseppe Boni
- Division of Nuclear Medicine, University Hospital of Pisa, Pisa, Italy
| | - Luca Galli
- Operative Unit of Medical Oncology 1, University Hospital of Pisa, Pisa, Italy
| | - Sergio Ricci
- Operative Unit of Medical Oncology 2, University Hospital of Pisa, Pisa, Italy
| | - Azzurra Farnesi
- Operative Unit of Medical Oncology 1, University Hospital of Pisa, Pisa, Italy
| | - Sara Mazzarri
- Division of Nuclear Medicine, University Hospital of Pisa, Pisa, Italy
| | - Claudia Cianci
- Operative Unit of Medical Oncology 1, University Hospital of Pisa, Pisa, Italy
| | - Giuliano Mariani
- Division of Nuclear Medicine, University Hospital of Pisa, Pisa, Italy
| | - Alfredo Falcone
- Operative Unit of Medical Oncology 1, University Hospital of Pisa, Pisa, Italy
| |
Collapse
|
8
|
Patients with bone metastases from solid tumors initiating treatment with a bone-targeted agent in 2011: a descriptive analysis using oncology clinic data in the US. Support Care Cancer 2014; 22:2697-705. [PMID: 24789499 DOI: 10.1007/s00520-014-2251-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 04/09/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Three bone-targeted agents (BTAs) are approved in the USA for prevention of bone complications among solid tumor patients with bone metastases: two intravenous bisphosphonates (IV BP) (pamidronate and zoledronic acid), and one subcutaneous receptor activator of nuclear factor-kappaB (RANK) ligand inhibitor (denosumab). Using electronic medical record data from outpatient community and hospital-affiliated oncology clinics, we examined the characteristics of patients who initiated treatment with a BTA in 2011 and followed them for a maximum of 12 months. METHODS Adult patients with bone metastasis secondary to solid tumors newly treated with a BTA during 2011 were identified from the Oncology Services Comprehensive Electronic Records (OSCER) database. We examined patient characteristics at BTA initiation, treatment patterns, and compliance during a 12-month period. Sensitivity analyses were performed in a subgroup of patients who had confirmed 12 months of follow-up data. RESULTS Denosumab patients (N = 1,594) were older (65 % ≥65 years vs. 60 % ≥65 years), further along in their disease progression (time since bone metastasis diagnosis: 16 % ≥2 years vs. 10 % ≥2 years), less likely to switch BTA (overall: 6 vs. 14 %; subgroup: 8 vs. 19 %), and more compliant with treatment (overall: median doses of 7 vs. 4; subgroup: 11 vs. 8) compared to IV BP patients (N = 1,975). Findings were consistent across gender, age, tumor type, naïve, and transition strata. CONCLUSIONS Patients receiving denosumab and IV BPs may differ. Despite higher age and more advanced disease, patients treated with denosumab are more likely to stay on treatment and have better compliance.
Collapse
|
9
|
Iakovou I, Doumas A, Badiavas K, Mpalaris V, Frangos S, Farmakis G. Pain palliative therapy in women with breast cancer osseous metastatic disease and the role of specific serum cytokines as prognostic factors. Cancer Biother Radiopharm 2014; 29:116-23. [PMID: 24392878 DOI: 10.1089/cbr.2013.1551] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To evaluate the efficacy of radionuclide palliative therapy (RPT) in women suffering from painful metastatic bone disease (MBD) due to breast cancer (BrCa), and to investigate the possible relationship between the RPT efficacy and cytokines levels. METHODS Sixty-three BrCa women patients with MBD enrolled in a prospective, nonrandomized study. Thirty were treated with Rhenium-186-hydroxyethylidenediphosphonic acid ((186)Re-HEDP), 21 with Strontium-89-Chloride ((89)Sr-Cl2), and 12 with Samarium-153-thylenediaminetetramethylenephosphonic acid ((153)Sm-EDTMP). Blood samples were collected pre- and post-therapy to assess the interleukin (IL)-2, IL-6 and tumor necrosis factor (TNF)-a titers. The palliative effect of the treatment was evaluated using a modified Wisconsin test. RESULTS All three radiopharmaceuticals were equally effective in pain relief. Pain palliation was complete in 52% of patients, partial in 31%, and absent in 16%. Responders to therapy had higher IL-2 and lower IL-6/TNF-a concentrations, compared with nonresponders, even though statistically significant difference in cytokines levels between responders and nonresponders before treatment was noted only for IL-6. CONCLUSION All used radiopharmaceuticals had the same therapeutic effect. Pretherapy low titers of IL-6 levels seems to have a favorable prognostic value for the therapeutic outcome, while IL-2 and TNF-a alterations pre- and post-therapy can only serve as markers of a better RPT response.
Collapse
Affiliation(s)
- Ioannis Iakovou
- 1 3rd Nuclear Medicine Department in Papageorgiou Hospital, Aristotle University , Thessaloniki, Greece
| | | | | | | | | | | |
Collapse
|
10
|
Safety and antitumor efficacy of 153Sm-EDTMP and docetaxel administered sequentially to patients with metastatic castration-resistant prostate cancer. Nucl Med Commun 2014; 35:88-94. [DOI: 10.1097/mnm.0000000000000023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
11
|
Vats K, Das T, Sarma HD, Banerjee S, Pillai M. Radiolabeling, Stability Studies, and Pharmacokinetic Evaluation of Thulium-170-Labeled Acyclic and Cyclic Polyaminopolyphosphonic Acids. Cancer Biother Radiopharm 2013; 28:737-45. [DOI: 10.1089/cbr.2013.1475] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kusum Vats
- Radiopharmaceuticals Division, Bhabha Atomic Research Centre, Mumbai, India
| | - Tapas Das
- Radiopharmaceuticals Division, Bhabha Atomic Research Centre, Mumbai, India
| | - Haladhar D. Sarma
- Radiation Biology and Health Sciences Division, Bhabha Atomic Research Centre, Mumbai, India
| | - Sharmila Banerjee
- Radiopharmaceuticals Division, Bhabha Atomic Research Centre, Mumbai, India
| | - M.R.A. Pillai
- Radiopharmaceuticals Division, Bhabha Atomic Research Centre, Mumbai, India
| |
Collapse
|
12
|
Das T, Pillai M. Options to meet the future global demand of radionuclides for radionuclide therapy. Nucl Med Biol 2013; 40:23-32. [DOI: 10.1016/j.nucmedbio.2012.09.007] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 09/05/2012] [Accepted: 09/10/2012] [Indexed: 01/09/2023]
|
13
|
Abstract
Primary and metastatic malignant bone lesions result in significant pain and disability in oncology patients. Targeted bone-seeking radioisotopes including 153Samarium ethylene-diamine-tetramethylene-phosphonic acid (153Sm-EDTMP) have been shown to effectively palliate bone pain, often when external beam radiotherapy (EBRT) is not feasible. However, recent evidence also suggests 153Sm-EDTMP has cytotoxic activity either alone or in combination with chemotherapy or EBRT. 153Sm-EDTMP may be useful as anti-neoplastic therapy apart from pain palliation in a variety of malignancies. For prostate cancer patients, several phase I and II clinical trials have shown that combined 153Sm-EDTMP and docetaxel-based chemotherapy can result in >50% decrease in prostate-specific antigen with manageable myelosuppression. In hematologic malignancies, 153Sm-EDTMP produced clinical responses when combined with bortezomib in multiple myeloma. 153Sm-EDTMP also can be used with myeloablative chemotherapy for marrow conditioning prior to stem cell transplant. In osteosarcoma, 153Sm-EDTMP infusion delivers radiation to multiple unresectable lesions simultaneously and provides local cytotoxicity without soft tissue damage that can be combined with chemotherapy or radiation. Prior to routine incorporation of 153Sm-EDTMP into therapeutic regimens, we must learn how to ensure optimal delivery to tumors, determine which patients are likely to benefit, improve our ability to assess clinical response in bone lesions and further evaluate the efficacy 153Sm-EDTMP in combination with chemotherapy, radiation and novel targeted agents.
Collapse
Affiliation(s)
- Breelyn A Wilky
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - David M Loeb
- Department of Pediatric Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| |
Collapse
|
14
|
Doré-Savard L, Beaudet N, Tremblay L, Xiao Y, Lepage M, Sarret P. A micro-imaging study linking bone cancer pain with tumor growth and bone resorption in a rat model. Clin Exp Metastasis 2012; 30:225-36. [PMID: 22956259 DOI: 10.1007/s10585-012-9530-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 08/21/2012] [Indexed: 02/06/2023]
Abstract
Bone metastases represent a frequent complication of advanced breast cancer. As tumor growth-induced bone remodeling progresses, episodes of severe pain and fractures of weight-bearing limbs increase. All of these skeletal-related events influence the patient's quality of life and survival. In the present study, we sought to determine whether some of these pain-related behaviors could be directly correlated to tumor progression and bone remodeling. For this purpose, we used a rat model of bone cancer pain based on the implantation of mammary carcinoma cells in the medullary cavity of the femur. The bone content and tumor growth were monitored over time by magnetic resonance imaging (MRI) and micro X-ray computed tomography (μCT). The same animals were evaluated for changes in their reflexive withdrawal responses to mechanical stimuli (allodynia) and weight-bearing deficits. As assessed by MRI, we found a negative correlation between tumor volume and allodynia or postural deficits throughout the experiment. Using μCT, we found that the bone volume/total volume (BV/TV) ratios for trabecular and cortical bone correlated with both mechanical hypersensitivity and weight-bearing impairment. However, whereas trabecular BV/TV stabilized between days 7 and 10 post-tumor detection, the cortical bone loss reached its maximum at that time. Our imaging approach also allowed us to consistently detect the tumor before the onset of pain, paving the way for the preemptive identification of at-risk patients. Altogether, these results improve our understanding of the events leading to tumor-induced bone pain and could eventually help in the design of novel strategies for the management of bone diseases.
Collapse
Affiliation(s)
- Louis Doré-Savard
- Department of Physiology and Biophysics, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, QC, Canada
| | | | | | | | | | | |
Collapse
|
15
|
Dennis K, Vassiliou V, Balboni T, Chow E. Management of bone metastases: recent advances and current status. ACTA ACUST UNITED AC 2012. [DOI: 10.1007/s13566-012-0058-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|
16
|
Tomblyn M. The Role of Bone-Seeking Radionuclides in the Palliative Treatment of Patients with Painful Osteoblastic Skeletal Metastases. Cancer Control 2012; 19:137-44. [DOI: 10.1177/107327481201900208] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background Pain from skeletal metastases represents a major burden of advanced disease from solid tumors. Analgesic medications, bisphosphonates, hormonal agents, cytotoxic chemotherapy, and external beam radiotherapy are all effective treatments. However, patients often suffer from diffuse painful metastases and respond poorly to these standard therapies. Bone-seeking radionuclides can specifically target osteoblastic lesions to offer palliation of pain. Methods This article offers a narrative review of bone-seeking radionuclides, examines the evidence of safety and efficacy for the treatment of painful skeletal metastases, and presents guidelines for their appropriate use in this patient population. Results Seven bone-seeking radionuclides have shown evidence of both safety and efficacy in reducing pain from diffuse skeletal metastases. 153Sm-EDTMP and 89Sr are most commonly used in the United States and have been safely utilized for both repeat dosing as well as concurrent dosing with cytotoxic chemotherapy. Conclusions Targeted bone-seeking radionuclides are underutilized in the treatment of painful diffuse osteoblastic metastases. Several new agents are in active clinical investigation, and the pending approval of the first alpha-emitting radionuclide (223Ra) may offer a new class of agents that provide greater efficacy and less toxicity than those currently available for routine clinical use.
Collapse
Affiliation(s)
- Michael Tomblyn
- Department of Radiation Oncology at the H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| |
Collapse
|