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The use of radiopharmaceuticals in the older patients with cancer task force

Background
Because of the complexity of the topic, it is likely that the task force will decide to concentrate on some specific aspects; taking also into account already published SIOG recommendations. This programme will not look at radiopharmaceuticals in hematologic malignancies.

According to EMA, radiopharmaceuticals are agents used to diagnose certain medical problems or treat certain diseases. They may be given to the patient in several different ways. Most radiopharmaceuticals are used for the purpose of medical diagnosis. They are usually given only once, or sometimes on a few occasions, and contain only small amounts of the active substances with a radionuclide attached to them to allow scintigraphic imaging or measurement of bio distribution. Such radiopharmaceuticals do not often show any measurable pharmacodynamic effect.

In the case of therapeutic radiopharmaceuticals, the radiation effect is the wanted property. Evaluation of the safety and efficacy of radiopharmaceuticals should include radiopharmaceutical and radiation hygiene aspects and radiation dosimetry in addition to general parameters.

A recent review indicates that skeletal metastases occur in many patients with different kinds of malignant tumours, especially in advance stage of breast cancer (in 47%-85% of patients), prostate cancer (33-85%), and lung cancer (32%-60%). The management of painful skeletal metastases is complicated and should be carried out by a multidisciplinary approach including conventional analgesics, antitumor therapy (chemo- and hormone therapy), osteoclast-inhibitory agents (bisphosphonates), corticosteroids, external-beam radiotherapy, surgery, and nuclear medicine therapy. The nuclear medicine therapy for palliation of pain from bone metastases is a systemic radionuclide therapy based on the use of radiopharmaceuticals. In several studies the efficacy of bone-seeking radiopharmaceuticals has been demonstrated in terms of pain reduction from diffuse skeletal metastases. In this review, we will summarize the current literature on bone-seeking radiopharmaceuticals for the treatment of painful bone metastases (Phosphorus-32, Strontium-89, Rhenium-186, Rhenium-188, Samarium-153, and Radium-223) and the combination therapy with bisphosphonates and chemotherapy.

Rubini G, Nicoletti A, Rubini D, Asabella AN. Radiometabolic treatment of bone-metastasizing cancer: from 186rhenium to 223radium. Cancer Biother Radiopharm. 2014 Feb;29(1):1-11. doi: 10.1089/cbr.2013.1549. Epub 2013 Nov 1.(Pubmed)

The recent progress in this field has not been discussed specifically in regards to elderly patients, who represent a majority of breast and prostate cancer patients.

Aims
T
he developments in the therapeutic use of radiopharmaceuticals with particular emphasis on elderly patients.

Task Force Members 

Chairs: Matti Aapro, Switzerland & John O. Prior, Switzerland

Writing Committee
William Dale, USA
Silke Gillessen, Switzerland
Wim Oyen, Netherlands
Manfred Wirth, Germany

Reviewing Committee
Axel Heidenreich (Germany)
Bertrand Tombal (Belgium)
Peter Mulders (Netherlands)
Gouri Shankar Bhattacharyya (India), SIOG Publication Committee

Publication

2017
The manuscript on Radiopharmaceuticals in the elderly cancer patient: practical considerations, with a focus on prostate cancer therapy: A position paper from a SIOG Task Force was accepted for publication in the European Journal of Cancer.

 This project was supported by an unrestricted grant from Bayer.