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223-Radium for metastatic osteosarcoma: combination therapy with other agents and external beam radiotherapy.
ESMO Open. 2020 Apr; 5(2)EO

Abstract

BACKGROUND

Bone-seeking radiopharmaceuticals can deposit radiation selectively to some osteosarcoma tumours because of the bone-forming nature of this cancer.

OBJECTIVES

This is the first report of using 223-radium, an alpha-emitting calcium analogue with a high therapeutic index, in combination therapy with other agents in 15 patients with metastatic osteoblastic osteosarcoma.

METHODS

Candidates for alpha-radiotherapy if 99mTc-MDP bone scan had avid bone-forming lesions and no therapy of higher priority (eg, definitive surgery). Monthly 223-radium infusions (1.49 μCi/kg or 55.13 kBq/kg) were given.

RESULTS

The median infusion number was three and the average time to progression was 4.3 months for this cohort receiving 223-radium+other agents. Agents provided during 223-radium included (1) drugs to reduce skeletal complications: monthly denosumab (n=13) or zolendronate (n=1); (2) agents with antivascular endothelial growth factor activity, pazopanib (n=8) or sorafenib (n=1), (3) alkylating agents: oral cyclophosphamide (n=1) or ifosfamide, given as a 14-day continuous infusion (n=1, two cycles), (4) high-dose methotrexate (n=1), pegylated liposomal doxorubicin (n=1); and (5) two other combinations: nivolumab and everolimus (n=1) and rapamycin and auranofin (n=1). Radiation therapy, including stereotactic body radiotherapy (SBRT), was also given to 11 patients concurrently with 223-radium (n=2), after 223-radium completion (n=3), or both concurrently and then sequentially for other sites (n=6). After 223-radium infusions, patients without RT had a median overall survival of 4.3 months compared with those with SBRT and/or RT, who had a median overall survival of 13.5 months.Conclusion Although only 1/15 of patients with osteoblastic osteosarcoma still remain alive after 223-radium, overall survival.

Authors+Show Affiliations

Pediatric Hematology/Oncology/BMT, Cleveland Clinic, Cleveland, Ohio, USA andersp@ccf.org.Radiation Oncology and Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA.Radiation Oncology, Cleveland Clinic, Cleveland, Ohio, USA.Pediatric Hematology/Oncology and BMT, Cleveland Clinic, Cleveland, Ohio, USA.Quantative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA.Nuclear Medicine, Cleveland Clinic, Cleveland, Ohio, USA.UT MD Anderson Cancer Center, Houston, Texas, USA.Radiation Oncology, Cleveland Clinic, Cleveland, Ohio, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32303572

Citation

Anderson, Pete M., et al. "223-Radium for Metastatic Osteosarcoma: Combination Therapy With Other Agents and External Beam Radiotherapy." ESMO Open, vol. 5, no. 2, 2020.
Anderson PM, Scott J, Parsai S, et al. 223-Radium for metastatic osteosarcoma: combination therapy with other agents and external beam radiotherapy. ESMO Open. 2020;5(2).
Anderson, P. M., Scott, J., Parsai, S., Zahler, S., Worley, S., Shrikanthan, S., Subbiah, V., & Murphy, E. (2020). 223-Radium for metastatic osteosarcoma: combination therapy with other agents and external beam radiotherapy. ESMO Open, 5(2). https://doi.org/10.1136/esmoopen-2019-000635
Anderson PM, et al. 223-Radium for Metastatic Osteosarcoma: Combination Therapy With Other Agents and External Beam Radiotherapy. ESMO Open. 2020;5(2) PubMed PMID: 32303572.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 223-Radium for metastatic osteosarcoma: combination therapy with other agents and external beam radiotherapy. AU - Anderson,Pete M, AU - Scott,Jacob, AU - Parsai,Shireen, AU - Zahler,Stacey, AU - Worley,Sarah, AU - Shrikanthan,Sankaran, AU - Subbiah,Vivek, AU - Murphy,Erin, PY - 2019/11/10/received PY - 2020/02/20/revised PY - 2020/02/21/accepted PY - 2020/4/19/entrez PY - 2020/4/19/pubmed PY - 2020/4/19/medline KW - 99mTc-MDP bone scan with SPECT CT KW - alpha emitter KW - bone-seeking radiopharmaceutical KW - osteoblastic metastases KW - stereotactic body radiotherapy (SBRT), JF - ESMO open JO - ESMO Open VL - 5 IS - 2 N2 - BACKGROUND: Bone-seeking radiopharmaceuticals can deposit radiation selectively to some osteosarcoma tumours because of the bone-forming nature of this cancer. OBJECTIVES: This is the first report of using 223-radium, an alpha-emitting calcium analogue with a high therapeutic index, in combination therapy with other agents in 15 patients with metastatic osteoblastic osteosarcoma. METHODS: Candidates for alpha-radiotherapy if 99mTc-MDP bone scan had avid bone-forming lesions and no therapy of higher priority (eg, definitive surgery). Monthly 223-radium infusions (1.49 μCi/kg or 55.13 kBq/kg) were given. RESULTS: The median infusion number was three and the average time to progression was 4.3 months for this cohort receiving 223-radium+other agents. Agents provided during 223-radium included (1) drugs to reduce skeletal complications: monthly denosumab (n=13) or zolendronate (n=1); (2) agents with antivascular endothelial growth factor activity, pazopanib (n=8) or sorafenib (n=1), (3) alkylating agents: oral cyclophosphamide (n=1) or ifosfamide, given as a 14-day continuous infusion (n=1, two cycles), (4) high-dose methotrexate (n=1), pegylated liposomal doxorubicin (n=1); and (5) two other combinations: nivolumab and everolimus (n=1) and rapamycin and auranofin (n=1). Radiation therapy, including stereotactic body radiotherapy (SBRT), was also given to 11 patients concurrently with 223-radium (n=2), after 223-radium completion (n=3), or both concurrently and then sequentially for other sites (n=6). After 223-radium infusions, patients without RT had a median overall survival of 4.3 months compared with those with SBRT and/or RT, who had a median overall survival of 13.5 months.Conclusion Although only 1/15 of patients with osteoblastic osteosarcoma still remain alive after 223-radium, overall survival. SN - 2059-7029 UR - https://www.unboundmedicine.com/medline/citation/32303572/223-Radium_for_metastatic_osteosarcoma:_combination_therapy_with_other_agents_and_external_beam_radiotherapy L2 - https://esmoopen.bmj.com/cgi/pmidlookup?view=long&pmid=32303572 DB - PRIME DP - Unbound Medicine ER -
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