Radionuclide Therapy Alleviates Cancer Bone Pain in Elderly

Abstract

Paris – Radionuclide therapy can alleviate painful bone metastases in 63%–75% of elderly men with prostate cancer, reducing the need for narcotic analgesics, according to the results of an 841-patient, retrospective, single-center study here. Investigators concluded that based on their experience at Hôpital René Huguenin in Saint-Cloud, France, treatment with strontium-89 chloride can be suggested as a “valuable supplement” to other treatments currently used. “Bone metastases are present in more than 90% of patients who die from prostate carcinomas,” Dr. Alain Pecking told attendees at the annual meeting of the International Society of Geriatric Oncology. In addition to pain, metastases in the bone can lead to fractures and neurologic symptoms, and can compress the spinal cord, he said, all of which can have a significant impact on the patient's ability to function normally and can increase their reliance on others to perform daily tasks. The rationale for using strontium-89 (Metastron), a bone-targeting, betaemitting radionuclide, is that many patients suffer from painful bone metastases despite using current therapies, which includes narcotic analgesics, hormonal treatments, chemotherapy, bisphosphonates, and external beam radiotherapy, Dr. Pecking said. The researchers studied the records of 841 patients with a median age of 73 years. Dr. Pecking reported that if there was a partial response or if the patient relapsed after a complete response to strontium-89, a second infusion was given to 268 men (median age, 71 years) and a third to 86 men (median age, 70 years). Patients who received one or two infusions had 12–16 metastatic sites, of which about 4 were painful, whereas those who needed three doses had about 7 painful sites. A complete or global response was defined as the disappearance of more than 80% of all painful metastatic bone sites and a significant decrease in the use of narcotic analgesics. A partial response was defined as a reduction in pain of more than 40% without any significant reduction in the daily use of narcotic analgesics. “From one infusion [of strontium-89] you have 63% good responses, and after two courses you have 75%,” Dr. Pecking said. A “good” response equated to the number of complete plus partial responses. The number of complete and partial responses after three doses of strontium-89 was 15.1% and 43%, respectively The time to response was 11 days following one infusion, 14 days after two infusions, and just over 15 days after three infusions. The duration of the pain-easing effect was longest (158 days) after one infusion, decreasing to 138 days after two and 101 days after three infusions. Pain was a common side effect of treatment, occurring in just fewer than quarter of patients during the first 15 days after an infusion. Spine neurologic syndrome was observed in three patients within 4 months after the infusion, and external radiation therapy was necessary in one case. Colitis was seen in 4.8% of patients, and grade 2–4 platelet toxicity was seen in 5.1%, 11.9%, and 13.2% of patients after the first, second, and third infusions, respectively. “Radionuclide therapy of painful bone metastases may improve the patient's quality of life in more than 60% of all treated cases and can be suggested as a valuable supplement to other modalities currently used,” Dr. Pecking said. Dr. Martine Extermann of the senior adult oncology program of the H. Lee Moffitt Cancer Center and Research Institute in Florida, noted that the study involved a “fairly large series of older patients, allowing a quantification of effect and safety assessment.” She added that “the good hematologic tolerance and reasonable effect duration of repeated injections in the elderly is a welcome finding.” She was not involved in the study. She has received research support, honoraria, or both from Amgen, Sanofi-Aventis, and GTX Inc. Dr. Pecking asserted no conflict of interest.