Treatment of painful bone metastases in prostate and breast cancer patients with the therapeutic radiopharmaceutical rhenium-188-HEDP

Rogier Lange; Floor Overbeek; John M. H. de Klerk; Pieternel C. M. Pasker-de Jong; Alexandra M. van den Berk; Rob ter Heine; Cees J. Rodenburg; Anko Kooistra; N. Harry Hendrikse; Haiko J. Bloemendal

doi:10.3413/Nukmed-0828-16-05

Nuklearmedizin - NuclearMedicine, Table of Contents

Nuklearmedizin 2016; 55(05): 188-195
DOI: 10.3413/Nukmed-0828-16-05

Original article

Schattauer GmbH

Treatment of painful bone metastases in prostate and breast cancer patients with the therapeutic radiopharmaceutical rhenium-188-HEDP

Clinical benefit in a real-world studyBehandlung schmerzender Knochenmetastasen bei Patienten mit Prostata- und Brustkrebs mit dem therapeutischen Radiopharmakon Rhenium-188-HEDPEine Studie zum klinischen Mehrwert in der täglichen Routine

Authors

Rogier Lange

¹Department of Clinical Pharmacy, Meander Medical Center, Amersfoort, The Netherlands
Floor Overbeek

¹Department of Clinical Pharmacy, Meander Medical Center, Amersfoort, The Netherlands

²Department of Pharmaceutical Sciences, Utrecht University, The Netherlands
John M. H. de Klerk

³Department of Nuclear Medicine, Meander Medical Center, Amersfoort, The Netherlands
Pieternel C. M. Pasker-de Jong

⁴Department of Research, Meander Academy, Meander Medical Center, Amersfoort, The Netherlands
Alexandra M. van den Berk

³Department of Nuclear Medicine, Meander Medical Center, Amersfoort, The Netherlands
Rob ter Heine

⁵Department of Pharmacy, Radboud University Medical Center, Nijmegen, The Netherlands
Cees J. Rodenburg

⁶Department of Internal Medicine/Medical Oncology, Meander Medical Center, Amersfoort, The Netherlands
Anko Kooistra

⁷Department of Urology, Meander Medical Center, Amersfoort, The Netherlands
N. Harry Hendrikse

⁸Departments of Clinical Pharmacology & Pharmacy and Radiology & Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
Haiko J. Bloemendal

⁶Department of Internal Medicine/Medical Oncology, Meander Medical Center, Amersfoort, The Netherlands

⁹Department of Medical Oncology, University Medical Center, Utrecht, The Netherlands

Abstract

Summary

Aim: Rhenium-188-HEDP (¹⁸⁸Re-HEDP) is an effective radiopharmaceutical for the palliative treatment of osteoblastic bone metastases. However, only limited data on its routine use are available and its effect on quality of life (QoL) has not been studied. Therefore, we evaluated the clinical benefit of ¹⁸⁸Re-HEDP in routine clinical care. Patients and methods: Prostate or breast cancer patients with painful bone metastases receiving ¹⁸⁸Re-HEDP as a routine clinical procedure were eligible for evaluation. Clinical benefit was assessed in terms of efficacy and toxicity. Pain palliation and QoL were monitored using the visual analogue scale (VAS), corrected for opioid intake, and the EORTC QLQ-C30 Global health status/QoL-scale. Thrombocyte and leukocyte nadirs were used to assess haematological toxicity. Results: 45 and 47 patients were evaluable for pain palliation and QoL, respectively. After a single injection of ¹⁸⁸Re-HEDP, the overall pain response rate was 69% and mean VAS-scores decreased relevantly and significantly (p < 0.05). Repeated treatment resulted in similar pain response. The overall QoL response rate was 68% and mean Global health status/QoL-scores increased relevantly and significantly. Haematological side effects were mild and transient. Conclusion: The clinically relevant response on pain and quality of life and the limited adverse events prove clinical benefit of treatment with ¹⁸⁸Re-HEDP and support its use in routine clinical care. Its effectiveness appears comparable to that of external beam radiotherapy.

Zusammenfassung

Ziel: Rhenium-188-HEDP (¹⁸⁸Re-HEDP) ist ein effektives Radiopharmakon für die palliative Behandlung von osteoblastischen Knochenmetastasen. Nur begrenzte Daten über die Routinebehandlung stehen zur Verfügung. Ihre Wirkung auf die Lebensqualität (QoL) wurde bisher nicht untersucht. Daher untersuchten wir den klinischen Mehrwert von ¹⁸⁸Re-HEDP in der klinischen Standardbehandlung. Patienten und Methoden: Patienten mit ossär metastasierten Prostata-oder Brustkrebs, die ¹⁸⁸Re-HEDP als Standardbehandlung erhalten haben, nahmen Teil an dieser Evaluation. Der klinische Mehrwert wurde auf die Effektivität und Toxizität untersucht. Die Schmerzlinderung wurde gemessen mit der Visuellen Analogskala (VAS), für Opioid-Einnahme korrigiert. Für die Auswertung von QoL wurde die EORTC QLQ-C30 Global health status/QoL-Skala verwendet. Die Thrombozyten und Leukozyten-Nadir wurden benutzt um die hämatologische Toxizität zu bewerten. Ergebnisse: Es wurden 45 Patienten für die Schmerzbehandlung beziehungsweise 47 Patienten für QoL ausgewertet. Nach einer einzigen Injektion betrug die gesamte Response-Rate auf Schmerzen 69% und die mittleren VAS-Werte sanken relevant und signifikant (p < 0,05). Die wiederholte Behandlung führte zu einer ähnlichen Schmerzreaktion. Die gesamte QoL-Ansprechrate war 68% und der mittlere Global health status/QoL-scores waren relevant und signifikant erhöht. Die hämatologischen Nebenwirkungen waren mild und vorübergehend. Schlussfolgerung: Die klinisch relevante Reaktion auf Schmerz und Lebensqualität und die begrenzte Toxizität beweisen den klinischen Mehrwert einer Behandlung mit ¹⁸⁸Re-HEDP. Es unterstützt die Verwendung in der klinischen Standardbehandlung. Seine Effektivität scheint vergleichbar zu sein mit externer Strahlentherapie.

Keywords

Bone metastases - radionuclide therapy - rhenium- 188-HEDP - pain palliation - quality of life - haematological toxicity

Schlüsselwörter

Knochenmetastasen - Radionuklidtherapie - Rhenium-188-HEDP - Schmerzlinderung - Lebens qualität - hämatologische Toxizität

Full Text

References

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