title: Beyond Palliation: Therapeutic Applications of153Samarium-EDTMP.
abstract: Primary and metastatic malignant bone lesions result in significant pain and disability in oncology patients. Targeted bone-seeking radioisotopes including153Samarium ethylene-diamine-tetramethylene-phosphonic acid (153Sm-EDTMP) have been shown to effectively palliate bone pain, often when external beam radiotherapy (EBRT) is not feasible. However, recent evidence also suggests153Sm-EDTMP has cytotoxic activity either alone or in combination with chemotherapy or EBRT.153Sm-EDTMP may be useful as anti-neoplastic therapy apart from pain palliation in a variety of malignancies. For prostate cancer patients, several phase I and II clinical trials have shown that combined153Sm-EDTMP and docetaxel-based chemotherapy can result in >50% decrease in prostate-specific antigen with manageable myelosuppression. In hematologic malignancies,153Sm-EDTMP produced clinical responses when combined with bortezomib in multiple myeloma.153Sm-EDTMP also can be used with myeloablative chemotherapy for marrow conditioning prior to stem cell transplant. In osteosarcoma,153Sm-EDTMP infusion delivers radiation to multiple unresectable lesions simultaneously and provides local cytotoxicity without soft tissue damage that can be combined with chemotherapy or radiation. Prior to routine incorporation of153Sm-EDTMP into therapeutic regimens, we must learn how to ensure optimal delivery to tumors, determine which patients are likely to benefit, improve our ability to assess clinical response in bone lesions and further evaluate the efficacy153Sm-EDTMP in combination with chemotherapy, radiation and novel targeted agents.
authors: Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors: Breelyn A
authors: BA
authors: Wilky
authors: Department of Pediatric Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors: David M
authors: DM
authors: Loeb
keywords: Bone Metastases; Osteosarcoma; Radiopharmaceutical; Samarium