Pediatric Hematology/Oncology/BMT, Cleveland Clinic, Cleveland, Ohio, USA
Radiation Oncology and Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA.
ESMO Open. 2020 Apr;5(2). doi: 10.1136/esmoopen-2019-000635.
Bone-seeking radiopharmaceuticals can deposit radiation selectively to some osteosarcoma tumours because of the bone-forming nature of this cancer.
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.
Candidates for alpha-radiotherapy if Tc-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/k) were given.
The median infusion number was three and the average time to progression was 4. months for this cohort receiving 223-radium+other agents. Agents provided during 223-radium included (1) drugs to reduce skeletal complications: monthly denosumab (n=1) 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. months compared with those with SBRT and/or RT, who had a median overall survival of 13. months.Conclusion Although only 1/15 of patients with osteoblastic osteosarcoma still remain alive after 223-radium, overall survival.
由于这种癌症具有成骨性质，因此骨靶向放射性药物可以选择性地将辐射沉积到一些骨肉瘤肿瘤中。
这是首次报告在 15 例转移性成骨骨肉瘤患者中使用 223 镭（一种具有高治疗指数的发射α粒子的钙类似物）与其他药物联合治疗。
如果 Tc-MDP 骨扫描有强烈的成骨病变且没有更高优先级的治疗（例如，确定性手术），则有资格接受α放射治疗。每月给予 223 镭输注（1.49μCi/kg 或 55.13kBq/kg）。
该队列接受 223 镭+其他药物的中位输注次数为 3 次，平均进展时间为 4.个月。在 223 镭期间给予的药物包括：（1）减少骨骼并发症的药物：每月 denosumab（n=1）或唑来膦酸（n=1）；（2）具有抗血管内皮生长因子活性的药物：pazopanib（n=8）或 sorafenib（n=1）；（3）烷化剂：口服环磷酰胺（n=1）或异环磷酰胺，连续输注 14 天（n=1，2 个周期）；（4）高剂量甲氨蝶呤（n=1），聚乙二醇脂质体阿霉素（n=1）；和（5）另外两种组合：nivolumab 和 everolimus（n=1）和 rapamycin 和 auranofin（n=1）。11 例患者在同时接受 223 镭（n=2）、完成 223 镭后（n=3）或同时序贯接受其他部位的放疗（n=6）。在 223 镭输注后，未接受 RT 的患者中位总生存期为 4.个月，而接受 SBRT 和/或 RT 的患者中位总生存期为 13.个月。结论：尽管只有 1/15 的成骨骨肉瘤患者在接受 223 镭后仍然存活，但总体生存率。
