H. Palmedo et al., Dose escalation study with rhenium-188 hydroxyethylidene diphosphonate in prostate cancer patients with osseous metastases, EUR J NUCL, 27(2), 2000, pp. 123-130
Citations number
20
Categorie Soggetti
Radiology ,Nuclear Medicine & Imaging","Medical Research Diagnosis & Treatment
The aim of this study was to determine the maximum tolerated dose of rheniu
m-188 hydroxyethylidene diphosphonate (HEDP) in prostate cancer patients wi
th osseous metastases who are suffering from bone pain, Twenty-two patients
received a single injection of escalating doses of carrier-added Re-188-HE
DP [1.3 GBq (35 mCi), 2.6 GBq (70 mCi), 3.3 GBq (90 mCi) and 4.4 GBq (120 m
Ci)]. Blood counts and biochemical parameters were measured weekly over a p
eriod of 8 weeks. Haematological toxicity (WHO grading) of grade 3 or 4 was
considered unacceptable. Clinical follow-up studies including methods of p
ain documentation (medication, pain diary) were performed for 6 months afte
r treatment, In the 1.3-GBq group. no haematological toxicity was observed.
First haematotoxic results were noted in those patients with a dose of 2.6
GBq Re-188-HEDP. In the 3.3-GBq group, one patient showed a reversible thr
ombopenia of grade 1, one a reversible thrombopenia of grade 2 and three a
reversible leukopenia of grade 1. In the 4.4-GBq group, thrombopenia of gra
des 3 and 4 was observed in one and two patients (baseline thrombocyte coun
t <200 x 10(9)/l), respectively, and leukopenia of grade 3 was documented i
n one patient. The overall nadir of thrombopenia was at week 4. The individ
ual, maximum percentage decrease in thrombocytes in the 1.3-, 2.6-, 3.3- an
d 4.4-GBq groups was 17%, 40%, 60% and 86%, respectively. In two patients,
a transient increase in serum creatinine was observed (max, 1.6 mg/dl). Pai
n palliation was reported by 64% of patients, with a mean duration of 7.5 w
eeks. The response rate seemed to increase with higher doses, reaching 75%
in the 4.4-GBq group, It is concluded that in prostate cancer patients, the
maximum tolerated dose of Re-188-HEDP is 3.3 GBq if the baseline thrombocy
te count is below 200x10(9)/l, In patients with thrombocyte counts signific
antly above 200x10(9)/1, a dose of 4.4 GBq might be tolerable, Thrombo- and
leukopenia are the most important side-effects, Pain palliation can be ach
ieved in 60%-75% of patients receiving a dose of 2.6 GBq or more of Re-188-
HEDP. Studies in a larger patient population are warranted to evaluate furt
her the palliative effect of Re-188-HEDP.