• 16-week duration of relief with a single 1.0 mCi/kg injection11

Bone Metastases

CANCER PAIN AND BONE METASTASES

POSITIVE BONE SCANS OBSERVED IN A VARIETY OF TUMOR TYPES

BONE METASTASES SCAN

aImages from Controlled Clinical Trials, EUSA Pharma.
bCourtesy of Gregory A. Wiseman, MD of the Mayo Clinic.


INCIDENCE

  • Most major solid tumors, as well as myeloma, have a propensity to involve bone
Tumor type Prevalence of bone metastases1
Prostate cancer 65% to 75%
Breast cancer 65% to 75%
Multiple myeloma 70% to 95%
Lung cancer 30% to 40%
Thyroid tumors 60%
Bladder cancer 40%
Renal cell carcinoma 20% to 25%

  • While some sites may be characterized by their radiological appearance as predominantly osteoblastic or predominantly osteolytic, it is now understood that most of these lesions have both a blastic and lytic component 3

THE MOST COMMON CAUSE OF PAIN IN ADVANCED CANCER

  • Even moderate pain may be difficult to control; incident pain, due to movement and commonly associated with bone metastases, can break through pain medications10
BONE METASTASES SCAN

MANAGING BONE INVOLVEMENT

Opioid analgesics Bisphosphonates
  • Initial pain control
  • Significant side effects, particularly as dosage increases6
  • May reduce the frequency of skeletal-related events7
  • Targets lytic component8
External beam radiation
  • Relatively rapid & durable impact
  • Not for more than a few lesions
Radiopharmaceuticals Chemotherapy
  • Administered as a single injection
  • Lesion-seeking action9
  • Varying degrees of myelosuppression
  • Addresses underlying disease
  • Bone metastases may indicate that disease has progressed1

A long-term management challenge

  • Breast cancer patients whose disease has spread to the skeleton only have a median survival time of 2 to 4 years2
  • Prostate cancer patients with even advanced bone metastases—associated with severe bone pain and potentially debilitating complications—have a median survival of about 2 to 3 years4

REFERENCES:

  1. Coleman RE. Metastatic bone disease: clinical features, pathophysiology and treatment strategies. Cancer Treat Rev. 2001;27:165-176.
  2. Guise TA, Kozlow WM, Heras-Herzig A, Padalecki SS, Yin JJ, Chirgwin JM. Molecular mechanisms of breast cancer metastases to bone. Clin Breast Cancer. 2005;5(suppl 2):S46-S53.
  3. Keller ET, Brown J. Prostate cancer bone metastases promote both osteolytic and osteoblastic activity. J Cell Biochem. 2004;91:718-729.
  4. Saad F, Clarke N, Colombel M. Natural history and treatment of bone complications in prostate cancer. Eur Urol. 2006;49:429-440.
  5. Berenson JR, Rajdev L, Broder M. Managing bone complications of solid tumors. Cancer Biol Ther. 2006;5:1078-1081.
  6. National Library of Medicine. Morphine Oral. What side effects can this medicine cause? Available at: http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a682133.html Accessed October 10, 2006.
  7. Berry S, Waldron T, Winquist E, Lukka H. The use of bisphosphonates in men with hormone-refractory prostate cancer: a systematic review of randomized trials. Can J Urol. 2006;13:3180-3188.
  8. Zometa® (zoledronic acid) prescribing information. December 2005.
  9. Quadramet (samarium Sm-153 lexidronam injection) prescribing information. September 2003.
  10. Mercadante S, Villari P, Ferrera P, Casuccio A. Optimization of opioid therapy for preventing incident pain associated with bone metastases. J Pain Symptom Manage. 2004;28:505-510.
  11. Serafini AN, Houston SJ, Resche I, et al. Palliation of pain associated with metastatic bone cancer using samarium-153 lexidronam: a double-blind placebo-controlled clinical trial. J Clin Oncol. 1998;16:1574-1581.