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 |
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Authors: | J M O’Sullivan A R Norman V R McCready G Flux F M Buffa B Johnson J Coffey G Cook J Treleaven A Horwich R A Huddart C C Parker D P Dearnaley |
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Institution: | (1) Department of Oncology, Queen’s University Belfast/Belfast City Hospital, Lisburn Road,, Belfast, BT9 7AB, UK;(2) Department of Computing, The Royal Marsden Foundation NHS Trust,, Sutton, Surrey, UK;(3) Department of Physics, The Royal Marsden Foundation NHS Trust,, Sutton, Surrey, UK;(4) Bob Champion Unit, The Royal Marsden Foundation NHS Trust,, Sutton, Surrey, UK;(5) Academic Unit of Urology, The Royal Marsden Foundation NHS Trust,, Sutton, Surrey, UK;(6) Department of Nuclear Medicine, The Royal Marsden Foundation NHS Trust,, Sutton, Surrey, UK;(7) Department of Haematology, The Royal Marsden Foundation NHS Trust,, Sutton, Surrey, UK |
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Abstract: | Purpose 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 186Re-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 186Re-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 186Re-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.
Conclusion 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. |
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Keywords: | Prostate cancer Bone metastases Radionuclide therapy Stem cell transplantation Palliation |
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