A phase 2 study of high-activity 186Re-HEDP with autologous peripheral blood stem cell transplant in progressive hormone-refractory prostate cancer metastatic to bone.
OBJECTIVE
We investigated the potential for improvement in disease control by use of autologous peripheral blood stem cell transplant (PBSCT) to permit administration of high activities of (186)Re-hydroxyethylidene diphosphonate (HEDP) in patients with progressive hormone-refractory prostate cancer (HRPC).


METHODS
Eligible patients had progressive HRPC metastatic to bone, good performance status and minimal soft tissue disease. Patients received 5,000 MBq of (186)Re-HEDP i.v., followed 14 days later by PBSCT. Response was assessed using PSA, survival, pain scores and quality of life.


RESULTS
Thirty-eight patients with a median age of 67 years (range 50-77) and a median PSA of 57 ng/ml (range 4-3,628) received a median activity of 4,978 MBq (186)Re-HEDP (range 4,770-5,100 MBq). The most serious toxicity was short-lived grade 3 thrombocytopenia in 8 (21%) patients. The median survival of the group is 21 months (95%CI 18-24 months) with Kaplan-Meier estimated 1- and 2-year survival rates of 83% and 40% respectively. Thirty-one patients (81%, 95% CI 66-90%) had stable or reduced PSA levels 3 months post therapy while 11 (29%, 95% CI 15-49%) had PSA reductions of >50% lasting >4 weeks. Quality of life measures were stable or improved in 27 (66%) at 3 months.


CONCLUSIONS
We have shown that it is feasible and safe to deliver high-activity radioisotope therapy with PBSCT to men with metastatic HRPC. Response rates and survival data are encouraging; however, further research is needed to define optimal role of this treatment approach.
Department of Oncology, Queen's University Belfast/Belfast City Hospital, Lisburn Road, Belfast, BT9 7AB, UK. joe.osullivan@qub.ac.uk
J M
JM
O'Sullivan
A R
AR
Norman
V R
VR
McCready
G
G
Flux
F M
FM
Buffa
B
B
Johnson
J
J
Coffey
G
G
Cook
J
J
Treleaven
A
A
Horwich
R A
RA
Huddart
C C
CC
Parker
D P
DP
Dearnaley
D000368:Aged; D001859:Bone Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000556:secondary / Q000628:therapy; D003131:Combined Modality Therapy; D019008:Drug Resistance, Neoplasm; D012968:Etidronic Acid / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009942:Organometallic Compounds / Q000627:therapeutic use*; D036102:Peripheral Blood Stem Cell Transplantation; D011471:Prostatic Neoplasms / Q000188:drug therapy / Q000532:radiotherapy* / Q000628:therapy*; D011868:Radioisotopes / Q000627:therapeutic use; D019275:Radiopharmaceuticals / Q000627:therapeutic use*; D012211:Rhenium / Q000627:therapeutic use; D014182:Transplantation, Autologous
D009942:Organometallic Compounds; D011868:Radioisotopes; D019275:Radiopharmaceuticals; C101598:rhenium-186 HEDP; D012211:Rhenium; D012968:Etidronic Acid