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Li H, Pei W, Yang X, Qu G, Hua Q, Liu L, Wang Y, Xu T, Chen Y. Biodistribution and dosimetry of 177Lu-DOTA-IBA for therapy of bone metastases. EJNMMI Res 2024; 14:30. [PMID: 38517637 PMCID: PMC10959900 DOI: 10.1186/s13550-024-01094-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/12/2024] [Indexed: 03/24/2024] Open
Abstract
BACKGROUND We designed and synthesized a novel bisphosphonate radiopharmaceutical (68 Ga- or 177Lu-labeled DOTA-ibandronate [68 Ga/177Lu-DOTA-IBA]) for the targeted diagnosis and treatment of bone metastases. The biodistribution and internal dosimetry of a single therapeutic dose of 177Lu-DOTA-IBA were evaluated using a series of single-photon emission computerized tomography (SPECT) images and blood samples. Five patients with multiple bone metastases were included in this prospective study. After receiving 1110 MBq 177Lu-DOTA-IBA, patients underwent whole-body planar, SPECT/CT imaging and venous blood sampling over 7 days. Dosimetric evaluation was performed for the main organs and tumor lesions. Safety was assessed using blood biomarkers. RESULTS 177Lu-DOTA-IBA showed fast uptake, high retention in bone lesions, and rapid clearance from the bloodstream in all patients. In this cohort, the average absorbed doses (ADs) in the bone tumor lesions, kidneys, liver, spleen, red marrow, bladder-wall, and osteogenic cells were 5.740, 0.114, 0.095, 0.121, 0.095, and 0.333 Gy/GBq, respectively. Although no patient reached the predetermined dose thresholds, the red marrow will be the dose-limiting organ. There were no adverse reactions recorded after the administration of 1110 MBq 177Lu-DOTA-IBA. CONCLUSION Dosimetric results show that the ADs for critical organs and total body are within the safety limit and with high bone retention. It is a promising radiopharmaceutical alternative for the targeted treatment of bone metastases, controlling its progression, and improving the survival and quality of life of patients with advanced bone metastasis.
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Affiliation(s)
- Hongmei Li
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, No 25 TaiPing St, Jiangyang District, Luzhou, 646000, Sichuan, People's Republic of China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, 646000, Sichuan, People's Republic of China
- Institute of Nuclear Medicine, Southwest Medical University, Luzhou, 646000, Sichuan, People's Republic of China
| | - Wenjie Pei
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, No 25 TaiPing St, Jiangyang District, Luzhou, 646000, Sichuan, People's Republic of China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, 646000, Sichuan, People's Republic of China
- Institute of Nuclear Medicine, Southwest Medical University, Luzhou, 646000, Sichuan, People's Republic of China
| | - Xiqun Yang
- Department of Dermatology, Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, People's Republic of China
| | - Gengcuo Qu
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, No 25 TaiPing St, Jiangyang District, Luzhou, 646000, Sichuan, People's Republic of China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, 646000, Sichuan, People's Republic of China
- Institute of Nuclear Medicine, Southwest Medical University, Luzhou, 646000, Sichuan, People's Republic of China
| | - Qingchu Hua
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, No 25 TaiPing St, Jiangyang District, Luzhou, 646000, Sichuan, People's Republic of China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, 646000, Sichuan, People's Republic of China
- Institute of Nuclear Medicine, Southwest Medical University, Luzhou, 646000, Sichuan, People's Republic of China
| | - Lin Liu
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, No 25 TaiPing St, Jiangyang District, Luzhou, 646000, Sichuan, People's Republic of China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, 646000, Sichuan, People's Republic of China
- Institute of Nuclear Medicine, Southwest Medical University, Luzhou, 646000, Sichuan, People's Republic of China
| | - Yudi Wang
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, No 25 TaiPing St, Jiangyang District, Luzhou, 646000, Sichuan, People's Republic of China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, 646000, Sichuan, People's Republic of China
- Institute of Nuclear Medicine, Southwest Medical University, Luzhou, 646000, Sichuan, People's Republic of China
| | - Tingting Xu
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, No 25 TaiPing St, Jiangyang District, Luzhou, 646000, Sichuan, People's Republic of China.
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, 646000, Sichuan, People's Republic of China.
- Institute of Nuclear Medicine, Southwest Medical University, Luzhou, 646000, Sichuan, People's Republic of China.
| | - Yue Chen
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, No 25 TaiPing St, Jiangyang District, Luzhou, 646000, Sichuan, People's Republic of China.
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, 646000, Sichuan, People's Republic of China.
- Institute of Nuclear Medicine, Southwest Medical University, Luzhou, 646000, Sichuan, People's Republic of China.
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2
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Dipalma G, Inchingolo AM, Malcangi G, Ferrara I, Viapiano F, Netti A, Patano A, Isacco CG, Inchingolo AD, Inchingolo F. Sixty-Month Follow Up of Clinical MRONJ Cases Treated with CGF and Piezosurgery. Bioengineering (Basel) 2023; 10:863. [PMID: 37508890 PMCID: PMC10376556 DOI: 10.3390/bioengineering10070863] [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: 06/21/2023] [Revised: 07/10/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
AIMS Medication-related osteonecrosis of the jaw (MRONJ) is a drug-related adverse reaction characterized by bone destruction and necrosis in the jaw. This case series aims to evaluate the treatment approaches and outcomes in MRONJ patients. MATERIALS AND METHODS The retrospective study was conducted at the Dental Unit of the University of Bari, Italy. Patients with MRONJ were treated and followed up for 60 months. The treatment approach involved piezosurgery and concentrated growth factor (CGF). Six clinical cases from this group are described in detail. RESULTS None of the patients showed recurrence of necrotic MRONJ lesions during the follow-up period. The surgical interventions, including bone resections and the application of CGF, resulted in successful mucosal healing and the prevention of disease progression. CONCLUSIONS This study highlights the complexity of managing MRONJ and the importance of a multidisciplinary approach. Conservative treatment options and minimally invasive surgery have shown efficacy in controlling symptoms and improving patients' quality of life. However, the optimal treatment approach remains a challenge, and further studies are needed to evaluate alternative therapies and resective surgery. A comprehensive preoperative evaluation and collaboration among dental, endocrinology, and oncology specialists are crucial for personalized and multidisciplinary management. Ongoing research efforts are necessary to explore new therapeutic modalities and improve our understanding of MRONJ management, providing better support to patients dealing with this complex condition.
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Affiliation(s)
- Gianna Dipalma
- Department of Interdisciplinary Medicine, School of Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Angelo Michele Inchingolo
- Department of Interdisciplinary Medicine, School of Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Giuseppina Malcangi
- Department of Interdisciplinary Medicine, School of Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Irene Ferrara
- Department of Interdisciplinary Medicine, School of Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Fabio Viapiano
- Department of Interdisciplinary Medicine, School of Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Anna Netti
- Department of Interdisciplinary Medicine, School of Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Assunta Patano
- Department of Interdisciplinary Medicine, School of Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Ciro Gargiulo Isacco
- Department of Interdisciplinary Medicine, School of Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Alessio Danilo Inchingolo
- Department of Interdisciplinary Medicine, School of Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Francesco Inchingolo
- Department of Interdisciplinary Medicine, School of Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
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3
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van der Zande K, Oyen WJG, Zwart W, Bergman AM. Radium-223 Treatment of Patients with Metastatic Castration Resistant Prostate Cancer: Biomarkers for Stratification and Response Evaluation. Cancers (Basel) 2021; 13:cancers13174346. [PMID: 34503156 PMCID: PMC8431634 DOI: 10.3390/cancers13174346] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/24/2021] [Accepted: 08/25/2021] [Indexed: 02/06/2023] Open
Abstract
Simple Summary Radium-223 dichloride ([223Ra]RaCl2; Ra-223) is an alpha-emitting radiopharmaceutical treatment for patients with metastatic castration resistant prostate cancer (mCRPC) with predominantly bone metastases. While responses to chemotherapeutic and antihormonal mCRPC treatments can be assessed by serum PSA levels, a decrease of serum PSA levels is not expected during Ra-223 therapy. Moreover, radiographic evaluation of bone metastases response is challenging. Therefore, novel biomarkers to select patients for Ra-223 treatment and monitoring response are urgently needed. In this review, we discuss the currently used and exploratory biomarkers for this purpose, including soluble and cellular factors detected in the peripheral blood, genetic defects and radiographic assessments. We conclude that some biomarkers, including metabolic products of collagen degradation and novel PET scan techniques, might hold promise as predictors of response to Ra-223 treatment. However, these biomarkers have not been extensively studied. Consequently, currently, no biomarker has established a place in patient stratification and response evaluation. Abstract Radium-223 dichloride ([223Ra]RaCl2; Ra-223) is a targeted alpha-emitting radiopharmaceutical which results in an overall survival and health related quality of life (HRQoL) benefit in symptomatic patients with metastatic castration resistant prostate cancer (mCRPC) and predominantly bone metastasis. Although effective, options to select patients who will derive treatment benefit and to monitor and predict treatment outcomes are limited. PSA response and radiographic evaluation are commonly used in mCRPC treatment assessment but are not informative in Ra-223 treated patients. Consequently, there is a clear need for predictive and prognostic tools. In this review, we discuss the physiology of bone metastases and the mechanism of action and efficacy of Ra-223 treatment, as well as offering an outline of current innovative prognostic and predictive biomarkers.
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Affiliation(s)
- Kim van der Zande
- Department of Medical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands;
- Division of Oncogenomics, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Wim J. G. Oyen
- Department of Nuclear Medicine, Rijnstate Hospital, Wagnerlaan 55, 6815 AD Arnhem, The Netherlands;
| | - Wilbert Zwart
- Division of Oncogenomics, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
- Oncode Institute, 3521 AL Utrecht, The Netherlands
- Correspondence: (W.Z.); (A.M.B.); Tel.: +31-2051-28156 (W.Z.); +31-2051-22569 (A.M.B.)
| | - Andries M. Bergman
- Department of Medical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands;
- Division of Oncogenomics, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
- Correspondence: (W.Z.); (A.M.B.); Tel.: +31-2051-28156 (W.Z.); +31-2051-22569 (A.M.B.)
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4
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Alghazo O, Eapen R, Koschel S, Cumberbatch M, Buteau J, Loh R, Lawrentschuk N, Murphy DG. The application of theranostics in different stages of prostate cancer. Future Oncol 2021; 17:3637-3644. [PMID: 34227404 DOI: 10.2217/fon-2020-1209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Despite the remarkable achievements in treating metastatic prostate cancer over the last two decades, castrate-resistant status is still considered the lethal stage of the disease. Theranostics combines a targeting compound (ligand) with a therapeutic radioisotope (radioactive particle) injected into the blood to target the cancer cells. The most studied radioligand is 177Lu-PSMA-617, which targets PSMA, a protein found in prostate cancer cells. This new approach has shown promising results in treating metastatic castration-resistant prostate cancer. Currently, many trials are using PSMA-targeting radioligands in combination with conventional therapies in advanced prostate cancer or even in the earlier stages of the disease. Other preclinical trials are exploring the possibility of using newer ligands or radioisotopes to treat prostate cancer to increase the specificity and efficacy of this treatment.
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Affiliation(s)
- Omar Alghazo
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne 3000, Australia.,Prostate Cancer Theranostics & Imaging Centre of Excellence, Peter MacCallum Cancer Centre, Melbourne 3000, Australia.,The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne 3000, Australia.,Urology Division, Clinical Sciences Department, Yarmouk University, Irbid 21163, Jordan
| | - Renu Eapen
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne 3000, Australia.,Prostate Cancer Theranostics & Imaging Centre of Excellence, Peter MacCallum Cancer Centre, Melbourne 3000, Australia.,The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne 3000, Australia
| | - Samantha Koschel
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne 3000, Australia
| | - Marcus Cumberbatch
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne 3000, Australia.,Department of Academic Urology, University of Sheffield, Sheffield, UK
| | - James Buteau
- Prostate Cancer Theranostics & Imaging Centre of Excellence, Peter MacCallum Cancer Centre, Melbourne 3000, Australia.,Molecular Imaging & Nuclear Medicine Therapeutics, Peter MacCallum Cancer Centre, Melbourne 3000, Australia
| | - Rebecca Loh
- Prostate Cancer Theranostics & Imaging Centre of Excellence, Peter MacCallum Cancer Centre, Melbourne 3000, Australia
| | - Nathan Lawrentschuk
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne 3000, Australia.,Prostate Cancer Theranostics & Imaging Centre of Excellence, Peter MacCallum Cancer Centre, Melbourne 3000, Australia.,Department of Urology, Royal Melbourne Hospital, Melbourne 3052, Australia.,E J Whitten Prostate Cancer Research Centre, Epworth Healthcare, Victoria 3121, Australia
| | - Declan G Murphy
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne 3000, Australia.,Prostate Cancer Theranostics & Imaging Centre of Excellence, Peter MacCallum Cancer Centre, Melbourne 3000, Australia.,The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne 3000, Australia
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5
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Drug and molecular radiotherapy combinations for metastatic castration resistant prostate cancer. Nucl Med Biol 2021; 96-97:101-111. [PMID: 33866131 DOI: 10.1016/j.nucmedbio.2021.03.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/24/2021] [Accepted: 03/24/2021] [Indexed: 12/24/2022]
Abstract
Metastatic castration resistant prostate cancer (mCRPC) is a highly lethal disease. Several novel therapies have been assessed in the past years. Targeting DNA damage response (DDR) pathways in prostate cancer became a promising treatment strategy and olaparib and rucaparib, Poly(ADP-ribose) polymerase (PARP) inhibitors, have been approved for patients carrying mutations in homologous recombination (HR) repair pathways. Other DDR inhibitor targets, such as ATM, ATR, CHK1, CHK2, and WEE1 are under extensive investigation. Additionally, molecular radiotherapy (MRT) including [177Lu]Lu-PSMA, [225Ac]Ac-PSMA, [223Ra]Ra-dichloride, [153Sm]-EDTMP, [188Re]Re-HDMP and GRPR-targeted MRT treat cancer through internal ionizing radiation causing DNA damage and demonstrate promising efficacy in clinical trials. In the field of immunotherapy, checkpoint inhibition as well as sipuleucel-T and PROSTVAC demonstrated only limited efficacy in mCRPC when used as monotherapy. This review discusses recent therapeutic strategies for mCRPC highlighting the need for rational combination of treatment options.
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6
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Yao Y, Li Z, Jiao D, Zhou X, Li J, Han X. Palliative local treatment of bone metastases by 125I seed brachytherapy under DynaCT guidance: single-center experience. Diagn Interv Radiol 2021; 27:558-563. [PMID: 33769288 DOI: 10.5152/dir.2021.20769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We aimed to evaluate the clinical benefit of 125I seed brachytherapy under DynaCT guidance for palliative local treatment of bone metastases. METHODS From December 2014 to September 2017, 82 patients with painful bone metastases, who experienced treatment failure using standard strategies or rejected treatment were enrolled in this retrospective study. All patients underwent 125I seed brachytherapy under DynaCT guidance. Technical success, visual analogue scale (VAS), numerical rating scale (NRS), verbal rating scale (VRS), Karnofsky performance status (KPS) and complications were analyzed. RESULTS The success rate of 125I seed implantation was 100%. The VAS and NRS scores for the most severe pain were 7.0 (5.0-9.0) and 8.0 (6.0-9.0) before brachytherapy. The pain scores assessed every 2 hours gradually decreased within 12 hours (p < 0.001). A comparison of KPS scores showed that patients had significantly better quality of life on weeks 1, 4, and 8 than on week 0 (p < 0.001). The associated complications were mild subcutaneous hemorrhage 25.6% (21/82), fever 7.3% (6/82), minor displacement of radioactive seeds 5.0% (4/82), pathologic fracture 2.4% (2/82), and local skin reaction 2.4% (2/82). After symptomatic treatment, all complications were relieved. Minor displacement of radioactive seeds did not cause damage to adjacent tissues. No serious life-threatening complications occurred in the study group. CONCLUSION DynaCT-guided 125I seed implantation is a safe and effective method for palliation of painful bone metastases from cancer after failure or rejection of conventional treatments.
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Affiliation(s)
- Yuan Yao
- Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhaonan Li
- Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Dechao Jiao
- Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xueliang Zhou
- Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jing Li
- Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xinwei Han
- Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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7
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Bjørklund G, Pivina L, Dadar M, Semenova Y, Chirumbolo S, Aaseth J. Long-Term Accumulation of Metals in the Skeleton as Related to Osteoporotic Derangements. Curr Med Chem 2021; 27:6837-6848. [PMID: 31333081 DOI: 10.2174/0929867326666190722153305] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 07/01/2019] [Accepted: 07/09/2019] [Indexed: 11/22/2022]
Abstract
The concentrations of metals in the environment are still not within the recommended limits as set by the regulatory authorities in various countries because of human activities. They can enter the food chain and bioaccumulate in soft and hard tissues/organs, often with a long half-life of the metal in the body. Metal exposure has a negative impact on bone health and may result in osteoporosis and increased fracture risk depending on concentration and duration of metal exposure and metal species. Bones are a long-term repository for lead and some other metals, and may approximately contain 90% of the total body burden in birds and mammals. The present review focuses on the most common metals found in contaminated areas (mercury, cadmium, lead, nickel, chromium, iron, and aluminum) and their effects on bone tissue, considering the possibility of the long-term bone accumulation, and also some differences that might exist between different age groups in the whole population.
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Affiliation(s)
- Geir Bjørklund
- Council for Nutritional and Environmental Medicine (CONEM), Toften 24, 8610 Mo i Rana, Norway
| | - Lyudmila Pivina
- Department of Internal Medicine, Semey Medical University, Semey, Kazakhstan,CONEM Kazakhstan Environmental Health and Safety Research Group, Semey Medical University, Semey, Kazakhstan
| | - Maryam Dadar
- Razi Vaccine and Serum Research Institute, Agricultural Research, Education and Extension Organization (AREEO), Karaj, Iran
| | - Yuliya Semenova
- Department of Internal Medicine, Semey Medical University, Semey, Kazakhstan,CONEM Kazakhstan Environmental Health and Safety Research Group, Semey Medical University, Semey, Kazakhstan
| | - Salvatore Chirumbolo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy,CONEM Scientific Secretary, Verona, Italy
| | - Jan Aaseth
- Research Department, Innlandet Hospital Trust, Brumunddal, Norway,Faculty of Health and Social Science, Inland Norway University of Applied Sciences,
Elverum, Norway
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8
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Majolo F, Caye B, Stoll SN, Leipelt J, Abujamra AL, Goettert MI. Prevention and Therapy of Prostate Cancer: An Update on Alternatives for Treatment and Future Perspectives. CURRENT DRUG THERAPY 2020. [DOI: 10.2174/1574885514666190917150635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Prostate cancer is one of the most prevalent cancer types in men worldwide. With the
progression of the disease to independent stimulation by androgen hormones, it becomes more difficult
to control its progress. In addition, several studies have shown that chronic inflammation is
directly related to the onset and progression of this cancer. For many decades, conventional chemotherapeutic
drugs have not made significant progress in the treatment of prostate cancer. However,
the discovery of docetaxel yielded the first satisfactory responses of increased survival of
patients. In addition, alternative therapies using biomolecules derived from secondary metabolites
of natural products are promising in the search for new treatments. Despite the advances in the
treatment of this disease in the last two decades, the results are still insufficient and conventional
therapies do not present the expected results they once promised. Thus, a revision and
(re)establishment of prostate cancer therapeutic strategies are necessary. In this review, we also
approach suggested treatments for molecular biomarkers in advanced prostate cancer.
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Affiliation(s)
- Fernanda Majolo
- Instituto do Cérebro do Rio Grande do Sul (InsCer), Programa de Pós-Graduação em Medicina e Ciências da Saúde, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Bruna Caye
- Laboratatório de Cultura de Células, Programa de Pós-Graduação em Biotecnologia, Universidade do Vale do Taquari – UNIVATES, Lajeado, Brazil
| | - Stefani Natali Stoll
- Laboratatório de Cultura de Células, Programa de Pós-Graduação em Biotecnologia, Universidade do Vale do Taquari – UNIVATES, Lajeado, Brazil
| | - Juliano Leipelt
- Laboratatório de Cultura de Células, Programa de Pós-Graduação em Biotecnologia, Universidade do Vale do Taquari – UNIVATES, Lajeado, Brazil
| | - Ana Lúcia Abujamra
- Laboratatório de Cultura de Células, Programa de Pós-Graduação em Biotecnologia, Universidade do Vale do Taquari – UNIVATES, Lajeado, Brazil
| | - Márcia Inês Goettert
- Laboratatório de Cultura de Células, Programa de Pós-Graduação em Biotecnologia, Universidade do Vale do Taquari – UNIVATES, Lajeado, Brazil
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9
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Zhou T, Zhou F, Guo J, Shi H, Yao X, Guo H, Yuan J, Tian Y, Zhang X, Wang S, Jiang Y, Zou Q, Zhou D, Li H, Li F, Lee JL, Chen CH, Park SH, Ng QS, Ma J, Zheng R, Ding Q, Liu X, Li R, Krissel H, Wagner VJ, Sun Y. Radium-223 in Asian patients with castration-resistant prostate cancer with symptomatic bone metastases: A single-arm phase 3 study. Asia Pac J Clin Oncol 2020; 17:462-470. [PMID: 33051982 PMCID: PMC9292681 DOI: 10.1111/ajco.13479] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 09/07/2020] [Indexed: 11/27/2022]
Abstract
Aim Radium‐223, a targeted alpha therapy, is approved widely for the treatment of patients with metastatic castrate‐resistant prostate cancer, based on a pivotal phase 3 study in predominantly white patients. We investigated the efficacy and safety of radium‐223 in Asian patients with castrate‐resistant prostate cancer and metastatic bone disease. Methods This multicenter, prospective, single‐arm, open‐label phase 3 trial evaluated the efficacy and safety of the standard radium‐223 regimen (55 kBq/kg every 4 weeks for six cycles) in patients from Asian countries. The primary endpoints were the safety and overall survival. Results A total of 226 patients were enrolled and received at least one dose of radium‐223. Median overall survival was 14.0 months (95% confidence interval [CI], 11.2–17.4). Median time to total alkaline phosphatase and prostate‐specific antigen progression were 7.5 (95% CI, 6.8–7.7) and 3.6 (95% CI, 3.1–3.7) months, respectively. Median skeletal‐related event‐free survival was 26.0 months (95% CI, 12.6–not reached). Grade ≥3 treatment‐emergent adverse events were reported in 103 (46%) of 226 patients, with anemia being the most common event (34 [15%] patients). Grade ≥3 drug‐related treatment‐emergent adverse events occurred in 39 (17%) of 226 patients. Serious treatment‐emergent adverse events were reported in 65 (29%) of 226 patients. Seven (3%) patients had an adverse event leading to death; none were considered to be related to radium‐223. Conclusion The results of this study support the use of the standard radium‐223 regimen for the treatment of Asian patients with castrate‐resistant prostate cancer and symptomatic bone metastases.
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Affiliation(s)
- Tie Zhou
- Changhai Hospital, Shanghai, China
| | - Fangjian Zhou
- Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Jianming Guo
- Shanghai Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hongcheng Shi
- Shanghai Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xudong Yao
- Shanghai Tenth People's Hospital, Shanghai, China
| | | | - Jian Yuan
- The First Affiliated Hospital of Guangzhou Medical University Hospital, Guangzhou, China
| | - Ye Tian
- Beijing Friendship Hospital of Capital Medical University Hospital, Beijing, China
| | - Xiaodong Zhang
- Beijing Chaoyang Hospital of Capital Medical University, Beijing, China
| | - Shuxia Wang
- Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yongguang Jiang
- Beijing An Zhen Hospital of Capital Medical University Hospital, Beijing, China
| | - Qing Zou
- Jiangsu Cancer Hospital, Nanjing, China
| | | | - Hanzhong Li
- Peking Union Medical College Hospital, Beijing, China
| | - Fang Li
- Peking Union Medical College Hospital, Beijing, China
| | - Jae Lyun Lee
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | | | - Se Hoon Park
- Sungkyunkwan University Samsung Medical Center, Seoul, Korea
| | | | - Jianhui Ma
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Rong Zheng
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qiang Ding
- Fudan University Huashan Hospital, Shanghai, China
| | - Xingdang Liu
- Fudan University Huashan Hospital, Shanghai, China
| | - Rui Li
- Bayer HealthCare Pharmaceuticals Inc., Whippany, NJ, USA
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Spine and Non-spine Bone Metastases - Current Controversies and Future Direction. Clin Oncol (R Coll Radiol) 2020; 32:728-744. [PMID: 32747153 DOI: 10.1016/j.clon.2020.07.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/21/2020] [Accepted: 07/10/2020] [Indexed: 02/06/2023]
Abstract
Bone is a common site of metastases in advanced cancers. The main symptom is pain, which increases morbidity and reduces quality of life. The treatment of bone metastases needs a multidisciplinary approach, with the main aim of relieving pain and improving quality of life. Apart from systemic anticancer therapy (hormonal therapy, chemotherapy or immunotherapy), there are several therapeutic options available to achieve palliation, including analgesics, surgery, local radiotherapy, bone-seeking radioisotopes and bone-modifying agents. Long-term use of non-steroidal analgesics and opiates is associated with significant side-effects, and tachyphylaxis. Radiotherapy is effective mainly in localised disease sites. Bone-targeting radionuclides are useful in patients with multiple metastatic lesions. Bone-modifying agents are beneficial in reducing skeletal-related events. This overview focuses on the role of surgery, including minimally invasive treatments, conventional radiotherapy in spinal and non-spinal bone metastases, bone-targeting radionuclides and bone-modifying agents in achieving palliation. We present the clinical data and their associated toxicity. Recent advances are also discussed.
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Scholl C, Bundschuh RA, Hirzebruch S, Glanert T, Wei X, Kürpig S, Rödel R, Essler M, Thomas L, Ahmadzadehfar H. Radionuclide intake risks in the clinical administration of 223RaCl 2. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2019; 39:387-398. [PMID: 30716726 DOI: 10.1088/1361-6498/ab044d] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
An intake monitoring program covering more than half a year of clinical administration of Radium-223-dichloride for the palliative treatment of castration-resistant prostate cancer was carried out in the nuclear medicine department of the university hospital Bonn. Radioactivity in a total of 87 samples of gloves, air filters, faecal bioassays and face masks was measured and evaluated to assess the need for radiation protection measures for the medical staff. The main aim was to quantify or obtain an upper limit for the intake factor. An intake factor of 10-8 was measured when the preparation of patient doses took place in part in a laminar flow cabinet, which indicates an intake factor of 10-7 in more commonplace practice without a cabinet. The intake factor is therefore at the same level as other standard applications of unsealed sources in nuclear medicine. Our findings confirmed that masks are not required under any circumstances. However, the investigation also revealed that contamination risks, especially during the preparation of doses in syringes, should not be neglected.
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Affiliation(s)
- Clemens Scholl
- Radiation Protection Department, Institute for Work Design of North-Rhine Westphalia, Gesundheitscampus 10, 44801 Bochum, Germany
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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.
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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
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Al-Salahi R, Moustapha ME, Abuelizz HA, Alharthi AI, Alburikan KA, Ibrahim IT, Marzouk M, Motaleb MA. Radioiodination and biodistribution of newly synthesized 3-benzyl-2-([3-methoxybenzyl]thio)benzo[ g]quinazolin-4-(3 H)-one in tumor bearing mice. Saudi Pharm J 2018; 26:1120-1126. [PMID: 30532632 PMCID: PMC6260473 DOI: 10.1016/j.jsps.2018.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 06/05/2018] [Indexed: 12/22/2022] Open
Abstract
3-Benzyl-2-((3-methoxybenzyl)thio)benzo[g]quinazolin-4(3H)-one was previously synthesized and proved by physicochemical analyses (HRMS, 1H and 13C NMR). The target compound was examined for its radioactivity and the results showed that benzo[g]quinazoline was successfully labeled with radioactive iodine using NBS via an electrophilic substitution reaction. The reaction parameters that affected the labeling yield such as concentration, pH and time were studied to optimize the labeling conditions. The radiochemical yield was 91.2 ± 1.22% and the in vitro studies showed that the target compound was stable for up to 24 h. The thyroid was among the other organs in which the uptake of 125I-benzoquinazoline has increased significantly over the time up to 4.1%. The tumor uptake was 6.95%. Radiochemical and metabolic stability of the benzoquinazoline in vivo/in vitro and biodistribution studies provide some insights about the requirements for developing more potent radiopharmaceutical for targeting the tumor cells.
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Affiliation(s)
- Rashad Al-Salahi
- Department of Pharmaceutical Chemistry, College of Pharmacy, King Saud University, P.O. Box 2457, Riyadh 11451, Saudi Arabia
| | - Moustapha E. Moustapha
- Department of Chemistry, College of Science and Humanities, Prince Sattam bin Abdulaziz University, P.O. Box 83, Al Kharj 11942, Saudi Arabia
| | - Hatem A. Abuelizz
- Department of Pharmaceutical Chemistry, College of Pharmacy, King Saud University, P.O. Box 2457, Riyadh 11451, Saudi Arabia
| | - Abdulrahman I. Alharthi
- Department of Chemistry, College of Science and Humanities, Prince Sattam bin Abdulaziz University, P.O. Box 83, Al Kharj 11942, Saudi Arabia
| | - Khalid A. Alburikan
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2457, Riyadh 11451, Saudi Arabia
| | - Ismail T. Ibrahim
- Labeled Compound Department, Hot Laboratories Centre, Atomic Energy Authority, P.O. Box 13759, Cairo, Egypt
| | - Mohamed Marzouk
- Department of Chemistry, College of Science and Humanities, Prince Sattam bin Abdulaziz University, P.O. Box 83, Al Kharj 11942, Saudi Arabia
- Chemistry of Natural Products Group, Center of Excellence for Advanced Sciences, National Research Centre, Dokki, Cairo 12622, Egypt
| | - Mohamed A. Motaleb
- Labeled Compound Department, Hot Laboratories Centre, Atomic Energy Authority, P.O. Box 13759, Cairo, Egypt
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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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Gdowski AS, Ranjan A, Vishwanatha JK. Current concepts in bone metastasis, contemporary therapeutic strategies and ongoing clinical trials. JOURNAL OF EXPERIMENTAL & CLINICAL CANCER RESEARCH : CR 2017; 36:108. [PMID: 28800754 PMCID: PMC5554406 DOI: 10.1186/s13046-017-0578-1] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 08/08/2017] [Indexed: 12/23/2022]
Abstract
Background Elucidation of mechanisms regulating bone metastasis has progressed significantly in recent years and this has translated to many new therapeutic options for patients with bone metastatic cancers. However, the rapid rate of progress in both the basic science literature and therapies undergoing clinical trials makes staying abreast with current developments challenging. This review seeks to provide an update on the current state of the science in bone metastasis research and give a snap shot of therapies in clinical trials for bone metastatic cancer. Main body Bone metastasis represents a difficult to treat clinical scenario due to pain, increased fracture risk, decreased quality of life and diminished overall survival outcomes. Multiple types of cancer have the specific ability to home to the bone microenvironment and cause metastatic lesions. This osteotropism was first described by Stephen Paget nearly 100 years ago as the ‘seed and soil’ hypothesis. Once cancer cells arrive at the bone they encounter a variety of cells native to the bone microenvironment which contribute to the establishment of bone metastatic lesions. In the first part of this review, the ‘seed and soil’ hypothesis is revisited while emphasizing recent developments in understanding the impact of native bone microenvironment cells on the metastatic process. Next, approved therapies for treating bone metastasis at the systemic level as well as those that target the bone microenvironment are discussed and current National Comprehensive Cancer Network (NCCN) guidelines relating to treatment of bone metastases are summarized. Finally, all open interventional clinical trials for therapies relating to treatment of bone metastasis have been complied and categorized. Conclusion Understanding the recent advancements in bone metastasis research is important for continued development of novel bone targeted therapies. The plethora of ongoing clinical trials will hopefully translate into improved treatments options for patients suffering from bone metastatic cancers.
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Affiliation(s)
- Andrew S Gdowski
- Institute for Molecular Medicine, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA.
| | - Amalendu Ranjan
- Institute for Molecular Medicine, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA
| | - Jamboor K Vishwanatha
- Institute for Molecular Medicine, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA
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Abstract
OBJECTIVE This article reviews recent developments in targeted radionuclide therapy (TRT) approaches directed to malignant liver lesions, bone metastases, neuroendocrine tumors, and castrate-resistant metastatic prostate cancer and discusses challenges and opportunities in this field. CONCLUSION TRT has been employed since the first radioiodine thyroid treatment almost 75 years ago. Progress in the understanding of the complex underlying biology of cancer and advances in radiochemistry science, multimodal imaging techniques including the concept of "see and treat" within the framework of theranostics, and universal traction with the notion of precision medicine have all contributed to a resurgence of TRT.
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17
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Xiang Z, Mo Z, Li G, Gilani S, Zhong Z, Zhang T, Zhang F, Gao F. 125I brachytherapy in the palliation of painful bone metastases from lung cancer after failure or rejection of conventional treatments. Oncotarget 2017; 7:18384-93. [PMID: 26919235 PMCID: PMC4951295 DOI: 10.18632/oncotarget.7584] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 02/11/2016] [Indexed: 12/02/2022] Open
Abstract
Purpose This study sought to assess the safety and effect of 125I seed implantation for palliation of painful bone metastases from lung cancer after failure or rejection of conventional treatments. Materials and Methods 89 patients with painful bone metastases secondary to lung cancer were consented and enrolled in this study from June 2013 to May 2015. All patients had failed or refused conventional treatments underwent percutaneous CT-guided 125I seed implantation. The Brief Pain Inventory (BPI) was used to measure pain intensity prior to treatment (T0), 2, 4, 6, 8 and 12 weeks (T2, T4, T6, T8 and T12) after treatment in a 24-hour period. Analgesic, quality of life (QOL) scores and complications were also recorded. Four patients were excluded as they were lost to follow-up or had incomplete data. Results 85 patients with 126 bone metastases from lung cancer were treated. There were significantly lower scores after treatment in the visual analog scale (VAS) and analgesic. The VAS scores for worst pain was 6.3±1.8 at T0. At T2, T4, T6, T8 and T12, the score in a 24-hour period decreased to 4.9±1.2 (P<0.01), 3.7±1.3 (P<0.01), 3.4±1.2 (P<0.01), 2.6±0.9 (P<0.01), and 1.4±0.8 (P<0.01) respectively. Comparison of QOL scores showed improvements including sleep, appetite, spiritual state, and fatigue at T2, T4, T6, T8 and T12 when compared to T0. No serious complications or massive bleeding were observed. Conclusions 125I brachytherapy is a safe and effective method for palliation of painful bone metastases from lung cancer after failure or rejection of conventional treatments.
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Affiliation(s)
- Zhanwang Xiang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Imaging and Intervention Therapy Department, Guangzhou 510060, Guangdong, China
| | - Zhiqiang Mo
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Imaging and Intervention Therapy Department, Guangzhou 510060, Guangdong, China
| | - Guohong Li
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Imaging and Intervention Therapy Department, Guangzhou 510060, Guangdong, China
| | - Saba Gilani
- Midtown Medical Center, Columbus, GA 31901, USA
| | - Zhihui Zhong
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Imaging and Intervention Therapy Department, Guangzhou 510060, Guangdong, China
| | - Tao Zhang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Imaging and Intervention Therapy Department, Guangzhou 510060, Guangdong, China
| | - Fujun Zhang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Imaging and Intervention Therapy Department, Guangzhou 510060, Guangdong, China
| | - Fei Gao
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Imaging and Intervention Therapy Department, Guangzhou 510060, Guangdong, China
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18
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Küronya Z, Sinkovics I, Ágoston P, Bíró K, Bodrogi I, Böde I, Dank M, Gyergyay F, Vajdics T, Kolonics Z, Nagyiványi K, Rúzsa Á, Géczi L. A Retrospective Analysis of the First 41 mCRPC Patients with Bone Pain Treated with Radium-223 at the National Institute of Oncology in Hungary. Pathol Oncol Res 2017; 23:777-783. [PMID: 28074331 DOI: 10.1007/s12253-017-0190-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 01/03/2017] [Indexed: 10/20/2022]
Abstract
Radium-223 dichloride is an alpha-emitting radiopharmaceutical which significantly prolongs overall survival in patients with castration-resistant prostate cancer (CRPC) and symptomatic bone metastases. This was a retrospective analysis of the efficacy and safety of Radium-223 in the first 41 patients treated at a single center in Hungary. Radium-223 was given at a dose of 50 kBq/kg intravenously every 4 weeks for up to 6 cycles. Between 23rd July 2014 and 23rd February 2016, 41 patients were treated. Patient demographics, laboratory values, treatment outcomes and adverse events were collected from medical records. The mean age was 72.2 years (SD: 7.1). 24 patients received Radium-223 as first-line treatment (58%), 7 patients as second (17%), 3 as third (7.3%), 6 as (14.6%), and 1 as fifth-line therapy (2.4%). The mean number of cycles administered was 5.5 (SD: 1.1). The most common side effects were anemia (32% grade 1-3), nausea (28%, grade 1), diarrhea (4%, grade 2), thrombocytopenia (4%, grade 3). The mean baseline PSA level was 307.2 ng/ml (SD: 525.7), which increased to a mean value of 728.5 ng/ml (SD: 1277) by the end of treatment. The baseline mean ALP of 521.1 U/L (SD: 728) decreased to 245.1 U/L (SD: 283.5). The majority of patients experienced a decrease (37%) or complete cessation (43%) of bone pain intensity. In our symptomatic prostate cancer patient population, Radium-223 proved to be efficient in terms of pain relief, with moderate side effects. No PSA response was detected, while alkaline phosphatase levels significantly decreased.
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Affiliation(s)
- Zs Küronya
- National Institute of Oncology, Ráth György u. 7-9, Budapest, H-1122, Hungary.
| | - I Sinkovics
- National Institute of Oncology, Ráth György u. 7-9, Budapest, H-1122, Hungary
| | - P Ágoston
- National Institute of Oncology, Ráth György u. 7-9, Budapest, H-1122, Hungary
| | - K Bíró
- National Institute of Oncology, Ráth György u. 7-9, Budapest, H-1122, Hungary
| | - I Bodrogi
- National Institute of Oncology, Ráth György u. 7-9, Budapest, H-1122, Hungary
| | - I Böde
- Jahn Ferenc South-Pest Hospital, Budapest, Hungary
| | - M Dank
- 1st Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - F Gyergyay
- National Institute of Oncology, Ráth György u. 7-9, Budapest, H-1122, Hungary
| | - T Vajdics
- National Institute of Oncology, Ráth György u. 7-9, Budapest, H-1122, Hungary
| | - Zs Kolonics
- Teaching Hospital Mór Kaposi, Kaposvár, Hungary
| | - K Nagyiványi
- National Institute of Oncology, Ráth György u. 7-9, Budapest, H-1122, Hungary
| | - Á Rúzsa
- Teaching Hospital Mór Kaposi, Kaposvár, Hungary
| | - L Géczi
- National Institute of Oncology, Ráth György u. 7-9, Budapest, H-1122, Hungary
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Menikou G, Yiannakou M, Yiallouras C, Ioannides C, Damianou C. MRI-compatible bone phantom for evaluating ultrasonic thermal exposures. ULTRASONICS 2016; 71:12-19. [PMID: 27261569 DOI: 10.1016/j.ultras.2016.05.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 05/15/2016] [Accepted: 05/24/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE The goal of the proposed study was the development of a magnetic resonance imaging (MRI) compatible bone phantom suitable for evaluating focused ultrasound protocols. MATERIALS AND METHODS High resolution CT images were used to segment femur bone. The segmented model was manufactured with (Acrylonitrile Butadiene Styrene) ABS plastic using a 3-D printer. The surrounding skeletal muscle tissue was mimicked using an agar-silica-evaporated milk gel (2% w/v-2% w/v-40% v/v). MR thermometry was used to evaluate the exposures of the bone phantom to focused ultrasound. RESULTS The estimated agar-silica-evaporated milk gel's T1 and T2 relaxation times in a 1.5T magnetic field were 776ms and 66ms respectively. MR thermometry maps indicated increased temperature adjacent to the bone, which was also shown in situations of real bone/tissue interfaces. CONCLUSION Due to growing interest of using MRI guided Focused Ultrasound Surgery (MRgFUS) in palliating bone cancer patients at terminal stages of the disease, the proposed bone phantom can be utilized as a very useful tool for evaluating ultrasonic protocols, thus minimizing the need for animal models. The estimated temperature measured and its distribution near the bone phantom/agar interface which was similar to temperatures recorded in real bone ablation with FUS, confirmed the phantom's functionality.
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Affiliation(s)
| | | | - Christos Yiallouras
- Cyprus University of Technology, Limassol, Cyprus; MEDSONIC LTD, Limassol, Cyprus
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20
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Yoshida K, Kaneta T, Takano S, Sugiura M, Kawano T, Hino A, Yamamoto T, Shizukuishi K, Kaneko M, Zurth C, Inoue T. Pharmacokinetics of single dose radium-223 dichloride (BAY 88-8223) in Japanese patients with castration-resistant prostate cancer and bone metastases. Ann Nucl Med 2016; 30:453-60. [PMID: 27272279 PMCID: PMC4961730 DOI: 10.1007/s12149-016-1093-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 05/08/2016] [Indexed: 12/04/2022]
Abstract
OBJECTIVE This open-label, non-randomized, phase I study examined the pharmacokinetics (PK) and radiation dosimetry of a single dose of radium-223 in Japanese patients with castration-resistant prostate cancer (CRPC) and bone metastases. METHODS Six male Japanese patients (mean age 72.5 years, range 65-79 years) with histologically or cytologically confirmed stage IV adenocarcinoma of the prostate were recruited. A single IV dose of radium-223 was delivered intravenously (IV) via slow bolus over a 2-5 min period: Cohort 1 received 50 kBq/kg and Cohort 2 received 100 kBq/kg. RESULTS Following IV injection, radium-223 was rapidly eliminated from the blood in a multi-phasic manner. The fraction of the injected activity of radium-223 retained in the whole body 24 h following injection was 85 %. Biodistribution results showed initial bone uptake was 52 % (range 41-57 %). The maximum activity of radium-223 in the bone was observed within 2 h of dosing. Activity of radium-223 passed through the small intestine within 24 h. No activity was detected in other organs. The major radiation dose from radium-223 was found in osteogenic cells; calculated absorbed doses in osteogenic cells and in the red marrow were 0.76 Gy/MBq and 0.09 Gy/MBq, respectively. CONCLUSIONS In Japanese patients with CRPC and bone metastases, radium-223 (IV) achieved maximum activity in the bone rapidly and passed through the intestine within 24 h, without signs of activity in other organs. The PK profile and absorbed radiation dose in organs and tissues in Japanese patients were similar to data from non-Japanese patients. Trial registration identification: NCT01565746.
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Affiliation(s)
- Keisuke Yoshida
- Department of Radiology, Yokohama City University, 3-9 Fukuura, Yokohama, 236-0004, Japan.
| | - Tomohiro Kaneta
- Department of Radiation Oncology/Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
| | - Shoko Takano
- Radiation Oncology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Madoka Sugiura
- Department of Radiology, Yokohama City University, 3-9 Fukuura, Yokohama, 236-0004, Japan
| | - Tsuyoshi Kawano
- Department of Radiology, Yokohama City University, 3-9 Fukuura, Yokohama, 236-0004, Japan
| | - Ayako Hino
- Department of Radiology, Yokohama City University, 3-9 Fukuura, Yokohama, 236-0004, Japan
| | - Tou Yamamoto
- Department of Diagnostic Radiology, Yokohama City University Medical Center, Yokohama, Japan
| | | | - Masato Kaneko
- Clinical Sciences Japan, Bayer Yakuhin Ltd., Osaka, Japan
| | | | - Tomio Inoue
- Department of Radiology, Yokohama City University, 3-9 Fukuura, Yokohama, 236-0004, Japan
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Menikou G, Yiallouras C, Yiannakou M, Damianou C. MRI-guided focused ultrasound robotic system for the treatment of bone cancer. Int J Med Robot 2016; 13. [DOI: 10.1002/rcs.1753] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 04/28/2016] [Accepted: 04/28/2016] [Indexed: 12/12/2022]
Affiliation(s)
| | - Christos Yiallouras
- Cyprus University of Technology; Limassol Cyprus
- Medsonic Ltd; Limassol Cyprus
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Nilsson S. Radionuclide Therapies in Prostate Cancer: Integrating Radium-223 in the Treatment of Patients With Metastatic Castration-Resistant Prostate Cancer. Curr Oncol Rep 2016; 18:14. [PMID: 26779616 PMCID: PMC4715854 DOI: 10.1007/s11912-015-0495-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Metastatic castration-resistant prostate cancer (mCRPC) frequently metastasizes to the bone, often resulting in painful skeletal events, reduced quality of life, and reduced survival. The beta-emitting radiopharmaceuticals strontium-89 and samarium-153 alleviated pain in mCRPC patients with widespread skeletal metastases and have been associated with myelotoxicity. Radium-223, a first-in-class alpha-emitting radiopharmaceutical, prolonged overall survival, delayed symptomatic skeletal events, and improved quality of life, versus placebo, in patients with CRPC and symptomatic bone metastases and no visceral metastases. Radium-223 provided survival benefit to patients with CRPC and symptomatic bone metastases, regardless of prior docetaxel use. Importantly, prostate-specific antigen level and pain palliation were not a measure of radium-223 treatment response and should not alter the decision to administer all six radium-223 injections, the recommended regimen for survival benefit. Radium-223 was generally well tolerated, leading to ongoing clinical trials in combination with other therapeutics. Thus, radium-223 is a valuable addition to the mCRPC treatment armamentarium.
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Affiliation(s)
- Sten Nilsson
- Department of Oncology-Pathology, Karolinska University Hospital, Karolinska Institutet, SE-17177, Solna, Sweden.
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Zacho HD, Karthigaseu NN, Fonager RF, Petersen LJ. Treatment with bone-seeking radionuclides for painful bone metastases in patients with lung cancer: a systematic review. BMJ Support Palliat Care 2016; 7:230-237. [DOI: 10.1136/bmjspcare-2015-000957] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 01/05/2016] [Indexed: 12/15/2022]
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Lubner SJ, Mullvain J, Perlman S, Pishvaian M, Mortimer J, Oliver K, Heideman J, Hall L, Weichert J, Liu G. A Phase 1, Multi-Center, Open-Label, Dose-Escalation Study of 131I-CLR1404 in Subjects with Relapsed or Refractory Advanced Solid Malignancies. Cancer Invest 2015; 33:483-9. [PMID: 26536061 DOI: 10.3109/07357907.2015.1081691] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This study explores the imaging and therapeutic properties of a novel radiopharmaceutical, (131)I-CLR1404. Phase 1a data demonstrated safety and tumor localization by SPECT-CT. This 1b study assessed safety, imaging characteristics, and possible antineoplastic properties and provided further proof-of-concept of phospholipid ether analogues' retention within tumors. A total of 10 patients received (131)I-CLR1404 in an adaptive dose-escalation design. Imaging characteristics were consistent with prior studies, showing tumor uptake in primary tumors and metastases. At doses of 31.25 mCi/m(2) and greater, DLTs were thrombocytopenia and neutropenia. Disease-specific studies are underway to identify cancers most likely to benefit from (131)I-CLR1404 monotherapy.
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Affiliation(s)
- Sam Joseph Lubner
- a University of Wisconsin Carbone Cancer Center , Madison , WI , USA
| | | | - Scott Perlman
- a University of Wisconsin Carbone Cancer Center , Madison , WI , USA
| | - Michael Pishvaian
- b Georgetown University Medical Center , Lombardi Cancer Center, Washington, DC , USA
| | - Joanne Mortimer
- c City of Hope Comprehensive Cancer Center , Duarte , CA , USA
| | | | - Jennifer Heideman
- a University of Wisconsin Carbone Cancer Center , Madison , WI , USA
| | - Lance Hall
- a University of Wisconsin Carbone Cancer Center , Madison , WI , USA
| | - Jamey Weichert
- a University of Wisconsin Carbone Cancer Center , Madison , WI , USA.,d Cellectar Biosciences , Madison , WI , USA
| | - Glenn Liu
- a University of Wisconsin Carbone Cancer Center , Madison , WI , USA
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Ranjbar H, Bahrami-Samani A, Yazdani MR, Ghannadi-Maragheh M. Determination of human absorbed dose of cocktail of 153Sm/177Lu-EDTMP, based on biodistribution data in rats. J Radioanal Nucl Chem 2015. [DOI: 10.1007/s10967-015-4324-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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27
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Fendler W, Wenter V, Stief C, Gratzke C, Bartenstein P. Nuklearmedizinische Therapie und Diagnostik in der Urologie. Urologe A 2015; 54:1025-35; quiz 1036-7. [DOI: 10.1007/s00120-014-3730-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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28
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Collins S, Pearce A, Ferreira K, Fenwick A, Regan P, Keightley J. Direct measurement of the half-life of 223Ra. Appl Radiat Isot 2015; 99:46-53. [DOI: 10.1016/j.apradiso.2015.02.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 02/02/2015] [Accepted: 02/04/2015] [Indexed: 10/24/2022]
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Yip K, McConnell H, Alonzi R, Maher J. Using routinely collected data to stratify prostate cancer patients into phases of care in the United Kingdom: implications for resource allocation and the cancer survivorship programme. Br J Cancer 2015; 112:1594-602. [PMID: 25791873 PMCID: PMC4453665 DOI: 10.1038/bjc.2014.650] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 11/20/2014] [Accepted: 12/01/2014] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Prostate cancer is the most commonly diagnosed malignancy in British men. The increasing use of PSA screening test has resulted in many more patients being diagnosed with this condition. Advances in its treatment have improved the survival rate among these patients. By 2040, the prevalence of prostate cancer survivors is expected to reach 830 000. Many of them will require medical support for the management of their progressive disease or long-term toxicities from previous treatments. Successful implementation of the cancer survivorship programme among these patients depends on a good understanding of their demand on the health care system. The aim of this study is to segment the population of prostate cancer survivors into different needs groups and to quantify them with respect to their phase of care. METHODS Incidence, survival, prevalence and mortality data collected and reported by cancer registries across the United Kingdom have been used for the current study to provide indicative estimates as to the number of prostate cancer patients in each phase of the care pathway in a year. RESULTS The majority of prostate cancer patients are in the post-treatment monitoring phase. Around a fifth of the patients are either receiving treatment or in the recovery and readjustment phase having completed their treatment in the preceding year. Thirteen percent have not received any anticancer treatment, a further 12% (32 000) have developed metastatic disease and 4% are in the final stage of their lives. CONCLUSION On the basis of our estimates, patients undergoing post-treatment monitoring phase will constitute the biggest group among prostate cancer survivors. The pressure to provide adequate follow-up care to these patients will be a challenge. There is limited data available to definitively quantify the number of prostate cancer patients who follow different pathways of care, and we hope this study has highlighted the importance of collecting and reporting of such data to help future health care planning for these patients.
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Affiliation(s)
- K Yip
- Mount Vernon Cancer Centre, Rickmansworth Road, Northwood, London HA6 2RN, UK
| | - H McConnell
- Macmillan Cancer Support, 89 Albert Embankment, London SE1 7UQ, UK
| | - R Alonzi
- Mount Vernon Cancer Centre, Rickmansworth Road, Northwood, London HA6 2RN, UK
| | - J Maher
- Mount Vernon Cancer Centre, Rickmansworth Road, Northwood, London HA6 2RN, UK
- Macmillan Cancer Support, 89 Albert Embankment, London SE1 7UQ, UK
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Markowski MC, Pienta KJ. Therapy decisions for the symptomatic patient with metastatic castration-resistant prostate cancer. Asian J Androl 2015; 17:936-8; discussion 938. [PMID: 25865849 PMCID: PMC4814966 DOI: 10.4103/1008-682x.150843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Metastatic prostate cancer continues to kill approximately 30,000 men per year. Since 2010, five new therapeutic agents have been Food and Drug Administration (FDA) approved to treat metastatic castration-resistant prostate cancer (mCRPC). With the increasing number of therapies available to clinicians, the most effective sequence in which to implement these treatments remains unknown. The presence or absence of symptoms (i.e., bony pain, visceral crisis) is a key parameter that informs the decision-making process regarding therapy. Treatment algorithms based on: 1) asymptomatic/minimal symptoms, 2) moderate symptoms or chemotherapy ineligible or 3) symptomatic disease need to be developed.
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Affiliation(s)
| | - Kenneth J Pienta
- Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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31
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Prologo JD, Passalacqua M, Patel I, Bohnert N, Corn DJ. Image-guided cryoablation for the treatment of painful musculoskeletal metastatic disease: a single-center experience. Skeletal Radiol 2014; 43:1551-9. [PMID: 24972918 DOI: 10.1007/s00256-014-1939-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 06/02/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE The role of image-guided thermal ablation techniques for the nonoperative local management of painful osseous metastatic disease has expanded during recent years, and several advantages of cryoablation in this setting have emerged. The purpose of this study is to retrospectively evaluate and report a single-center experience of CT-guided percutaneous cryoablation in the setting of painful musculoskeletal metastatic disease. METHODS This study was approved by the institutional review board and is compliant with the Health Insurance Portability and Accountability Act. Electronic medical records of all patients who underwent percutaneous image-guided palliative cryoablation at our institution were reviewed (n = 61). An intent-to-treat analysis was performed. Records were reviewed for demographic data and anatomical data, primary tumor type, procedure details, and outcome-including change in analgesic requirements (expressed as morphine equivalent dosages), pain scores (utilizing the clinically implemented visual analog scale), subsequent therapies (including radiation and/or surgery), and complications during the 24 h following the procedure and at 3 months. Patients were excluded (n = 7) if data were not retrospectively identifiable at the defined time points. RESULTS Fifty-four tumors were ablated in 50 patients. There were statistically significant decreases in the median VAS score and narcotic usage at both 24 h and 3 months (p < 0.000). Six patients (11%) incurred complications related to their therapy. Two patients had no relief at 24 h, of which both reported worsened pain at 3 months. One patient had initial relief but symptom recurrence at 3 months. Four patients went on to have radiation therapy of the ablation site at some point following the procedure. CONCLUSIONS CT-guided cryoablation is a safe, effective, reproducible procedural option for the nonoperative local treatment of painful musculoskeletal metastatic disease.
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Affiliation(s)
- J David Prologo
- Emory University Hospital, Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-Guided Medicine, 1364 Clifton Road, NE Suite D112, Atlanta, GA, 30322, USA,
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Turner PG, O'Sullivan J. Radium-223 dichloride for the treatment of metastatic prostate cancer. Expert Opin Pharmacother 2014; 15:2105-11. [PMID: 25186336 DOI: 10.1517/14656566.2014.955016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Bone metastases are a frequent complication of many malignancies and are particularly common in metastatic prostate cancer, where they are associated with a high degree of morbidity. Until recently, treatments relied on palliative bone targeting measures with no proven survival-prolonging action or on systemic agents with general anti-prostate cancer activity but significant toxicities. Radium-223 dichloride is a bone-seeking, α-emitting, radionuclide that has recently been licensed in the US and Europe for the treatment of men with castration-resistant prostate cancer, bone metastases and no known visceral metastases. Radium-223 is the first bone-seeking radionuclide therapy proven to result in increased overall survival versus placebo. AREAS COVERED The existing market of bone-targeted agents is reviewed before considering what radium-223 adds by examining its pharmacology, pharmacokinetics and clinical efficacy and safety data. Initial relevant papers were identified by searching PubMed using combinations of the terms, 'Radium', 'Prostatic neoplasms', 'Bone', 'Neoplasm metastasis'. EXPERT OPINION Consideration is given to further preclinical work needed into the mechanism of action of radium-223 and future clinical directions of the drug including combinations with other agents.
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Affiliation(s)
- Philip Geoffrey Turner
- Clinical Research Fellow, Northern Ireland Cancer Centre , 51 Lisburn Road, Belfast, BT97AB , UK +44 0 7825871500 ; +44 0 28 90699214 ;
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Abstract
Medical oncology is moving toward personalized and precision treatments. This evolution is spearheaded by ongoing discoveries on the fundamental machinery that controls tumor and hosts microenvironment biological behavior. α-Particles with their high energy and short range had long been recognized as potentially useful in the treatment of cancer. More than a century after the discovery of radium by the Curies, 223Ra dichloride is now available in the expanding armamentarium of therapies for metastatic castration-resistant prostate cancer. This advance occurs in the context of several other novel therapeutics in advanced prostate cancer that include more effective androgen receptor pathway inhibition, better chemotherapy, and immunotherapy. We present a concise review on the therapeutic use of 223Ra dichloride in this clinically important setting including excerpts on the radium history, physical properties, the alpharadin in symptomatic prostate cancer clinical trial, and practical information on its use in the clinic. It is anticipated that, with the current emergence of 223Ra as a viable form of therapy, interest in and use of α-particle therapy in the management of cancer will grow.
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Correa-González L, Arteaga de Murphy C, Pichardo-Romero P, Pedraza-López M, Moreno-García C, Correa-Hernández L. 153Sm-EDTMP for Pain Relief of Bone Metastases from Prostate and Breast Cancer and Other Malignancies. Arch Med Res 2014; 45:301-8. [DOI: 10.1016/j.arcmed.2014.03.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 03/14/2014] [Indexed: 10/25/2022]
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Minimally invasive local treatments for bone and pulmonary metastases. Minim Invasive Surg 2014; 2014:719394. [PMID: 24672718 PMCID: PMC3942283 DOI: 10.1155/2014/719394] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 12/26/2013] [Indexed: 12/02/2022] Open
Abstract
Surgery and chemotherapy have historically been the mainstay of treatment in patients with metastatic disease. However there are many alternative therapies available to relieve the symptoms and morbidity of metastases. In this paper, we review the role and highlight the advantages of minimally invasive techniques employed in patients with pulmonary and bone metastases.
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Kluetz PG, Pierce W, Maher VE, Zhang H, Tang S, Song P, Liu Q, Haber MT, Leutzinger EE, Al-Hakim A, Chen W, Palmby T, Alebachew E, Sridhara R, Ibrahim A, Justice R, Pazdur R. Radium Ra 223 dichloride injection: U.S. Food and Drug Administration drug approval summary. Clin Cancer Res 2014; 20:9-14. [PMID: 24190979 DOI: 10.1158/1078-0432.ccr-13-2665] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
On May 15, 2013, the U.S. Food and Drug Administration (FDA) approved radium Ra 223 dichloride (Ra-223; Xofigo injection; Bayer HealthCare Pharmaceuticals Inc.) for the treatment of patients with castration-resistant prostate cancer (CRPC), symptomatic bone metastases, and no known visceral metastatic disease. The FDA review was based on clinical trial BC1-06, which randomly allocated patients (2:1) to either Ra-223 plus best standard of care (BSoC) or placebo plus BSoC. The primary endpoint was overall survival (OS) with a key secondary endpoint of time to first symptomatic skeletal event (SSE). A statistically significant improvement in OS was demonstrated [HR, 0.70; 95% confidence interval, 0.55-0.88, P = 0.0019]. At the prespecified interim analysis, the median OS durations were 14.0 and 11.2 months in the Ra-223 and placebo arms, respectively. The improvement in OS was supported by a delay in time to first SSE favoring the Ra-223 arm. The most common (>10%) adverse reactions in patients receiving Ra-223 were nausea, diarrhea, vomiting, and peripheral edema. The most common (>10%) hematologic laboratory abnormalities were anemia, lymphocytopenia, leukopenia, thrombocytopenia, and neutropenia. Ra-223 is the first α-emitting radiotherapeutic and the first radiopharmaceutical to demonstrate an OS advantage in metastatic prostate cancer.
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Affiliation(s)
- Paul G Kluetz
- Authors' Affiliations: Office of Hematology and Oncology Products, Office of Biostatistics, Office of Clinical Pharmacology, and Office of Pharmaceutical Science, Office of New Drug Quality Assessment, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland
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Nilsson S. Alpha-emitter radium-223 in the management of solid tumors: current status and future directions. Am Soc Clin Oncol Educ Book 2014:e132-e139. [PMID: 24857093 DOI: 10.14694/edbook_am.2014.34.e132] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Bone metastases, which are commonly seen in patients with advanced cancers, are a major cause of skeletal events, disability, and death. Radium-223 dichloride (radium-223; Xofigo, formerly Alpharadin), a first-in-class, alpha-emitting radiopharmaceutical that selectively targets bone metastases with high-energy short-range alpha-particles, has been approved for the treatment of patients with castration-resistant prostate cancer (CRPC) with symptomatic bone metastases and no known visceral metastases. Approval is based on results of the randomized phase III trial Alpharadin in Symptomatic Prostate Cancer (ALSYMPCA), in which radium-223 prolonged overall survival and time to first symptomatic skeletal event versus placebo among patients with CRPC with symptomatic bone metastases and was generally well tolerated, with low myelosuppression rates and manageable gastrointestinal adverse events. Long-term follow-up of the ALSYMPCA safety population showed that the incidence of myelosuppression remained low among patients treated with radium-223, with no additional safety issues of acute myelogenous leukemia, myelodysplastic syndrome, aplastic anemia, or primary bone cancer within approximately 1.5 years after treatment. The radium-223 overall survival benefit and low toxicity make it an effective, well-tolerated, and novel treatment option for CRPC and symptomatic bone metastases and opens the possibility of exploring radium-223 in the treatment of bone metastases from other cancers. A phase I clinical trial of patients with breast and prostate cancer with skeletal metastases demonstrated that radium-223 was safe and well tolerated at all therapeutically relevant dosages. Moreover, a phase IIa trial of patients with advanced breast cancer and progressive bone-dominant disease demonstrated that radium-223 targeted areas of increased bone metabolism and showed biologic activity.
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Affiliation(s)
- Sten Nilsson
- From the Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
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Abstract
Prostate cancer is the most common cancer in men worldwide, accounting for approximately 242,000 new cases and 28,000 deaths annually in the USA. Although localized disease is often curable, advanced disease is generally not, especially when the cancer becomes castration-resistant and metastasizes to bone. Fortunately, advances in research have led to the recent approval of several novel therapies for the treatment of metastatic disease, and many other promising agents are in development. With this success arises the distinct challenge of optimizing both sequencing and the design of rational combinations with these agents. This review focuses on practical and experimental approaches to this challenge.
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Chung PH, Gayed BA, Thoreson GR, Raj GV. Emerging drugs for prostate cancer. Expert Opin Emerg Drugs 2013; 18:533-50. [DOI: 10.1517/14728214.2013.864635] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Jackson MR, Falzone N, Vallis KA. Advances in anticancer radiopharmaceuticals. Clin Oncol (R Coll Radiol) 2013; 25:604-9. [PMID: 23870756 DOI: 10.1016/j.clon.2013.06.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 05/16/2013] [Accepted: 06/12/2013] [Indexed: 12/19/2022]
Abstract
This review highlights recent progress in the development of anticancer radiopharmaceuticals. Molecularly targeted radiotherapy refers to the selective delivery of radionuclides that emit charged particles, such as α particles, β or Auger electrons, to cancer cells via a targeting vector. The discovery of new molecular targets through systems biology and other approaches has widened the scope for radiopharmaceutical development. Innovations in antibody engineering and humanisation, recombinant DNA technology, conjugation chemistry and, increasingly, nanotechnology have provided new approaches to the delivery of radionuclides to cancer cells. The increased availability of radioisotopes that have not traditionally been considered for therapy, such as α particle emitters, has also broadened the indications for targeted radiotherapy.
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Affiliation(s)
- M R Jackson
- CR-UK/MRC Gray Institute for Radiation Oncology and Biology, University of Oxford, Oxford, UK
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Brady D, O'Sullivan JM, Prise KM. What is the Role of the Bystander Response in Radionuclide Therapies? Front Oncol 2013; 3:215. [PMID: 23967404 PMCID: PMC3746502 DOI: 10.3389/fonc.2013.00215] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 08/05/2013] [Indexed: 12/31/2022] Open
Abstract
Radionuclide therapy for cancer is undergoing a renaissance, with a wide range of radionuclide and clinical delivery systems currently under investigation. Dosimetry at the cellular and sub-cellular level is complex with inhomogeneity and incomplete targeting of all cells such that some tumor cells will receive little or no direct radiation energy. There is now sufficient preclinical evidence of a Bystander response which can modulate the biology of these un-irradiated cells with current research demonstrating both protective and inhibitory responses. Dependence upon fraction of irradiated cells has also been found and the presence of functional gap junctions appears to be import for several Bystander responses. The selection of either high or low LET radionuclides may be critical. While low LET radionuclides appear to have a Bystander response proportional to dose, the dose-response from high LET radionuclides are more complex. In media transfer experiments a “U” shaped response curve has been demonstrated for high LET treatments. However this “U” shaped response has not been seen with co-culture experiments and its relevance remains uncertain. For high LET treatments there is a suggestion that dose rate effects may also be important with inhibitory effects noted with 125I labelling study and a stimulatory seen with 123I labelling in one study.
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Affiliation(s)
- Darren Brady
- Centre for Cancer Research and Cell Biology, Queen's University Belfast , Belfast , UK
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