3 oktober 2011: Bron: European Multidisciplinary Cancer Congress (EMCC): Abstract 7LBA. Presented September 25, 2011

Wanneeer mannen met in de botten uitgezaaide prostaatkanker 1 keer plaatselijk worden bestraald geeft dat hetzelfde effect op het wegnemen van de pijn als het nemen van ibandronate, een bisfosfonaat. Echter de mediane overleving is bij ibandronate behoorljk langer dan als er alleen bestraald wordt. Overigens is dit laatste la veel langer bekend ook van Zometa en denosumab en was ook niet een doel van deze studie. De resultaten van een gerandomiseerde cross-over studie (patienten konden gedurende de studie overstappen naar de andere groep), toont aan dat zowel 1 keer bestralen op de pijnlijke plaats in het wegnemen van de pijn nagenoeg gelijk staat aan dagelijks 6 mg. Ibandronate, met een lichte voorkeur voor bestralen op het direct wegnemen van de pijn. Na een jaar was er geen verschil meer tussen pijnbeleving tussen beide manieren van aanpak. Hier de studieresultaten. Als u hier klikt kunt u bij Medscape een groter artikel hierover lezen

The standard treatment of a single dose of radiation for bone metastases in men with prostate cancer provided relief similar to that seen after an intravenous dose of the bisphosphonate ibandronate (Boniva)

Source: Medscape

Slight Differences in Pain Relief

The trial was conducted in 470 patients with prostate cancer and painful bone metastases. They were randomized to receive either a single dose of radiation (8 Gy) or a single intravenous infusion of ibandronate (6 mg).

A combination of 2 measures of pain relief were used: the World Health Organization (WHO) pain ladder; and the Mercadante score, which measures analgesic use in morphine equivalents (an appositive difference from baseline indicates worsening pain relief).

At 4 weeks, the WHO response rate was 53% in the radiotherapy group, and 49% in the ibandronate group (P = .49), and the Mercadante score was –3.2 units in the radiotherapy group and +1.2 units in the ibandronate group (P = .11).

However, the proportion of patients with a high score difference at 4 weeks (≥5.86 units) was 10% for radiotherapy and 20% for ibandronate (P = .004), Dr. Hoskin noted.

At 6 months, the mean differences were +3.99 for radiotherapy and +1.95 for ibandronate (P = .66); at 12 months, there was no difference.

Patients who reported no benefit from therapy at 4 weeks were allowed to cross over into the other treatment group. In all, 24% of patients initially treated with radiotherapy switched to ibandronate, and 31% of those initially treated with ibandronate switched to radiotherapy (P = .10).

Median overall survival was 11.8 months for radiotherapy alone, 11.4 months for ibandronate alone, 12.7 months for radiotherapy followed by ibandronate, and 16.8 months for ibandronate followed by radiotherapy.

Dr. Hoskin noted that "although there were more patients in the ibandronate group with worse Mercadante scores who need retreatment at the 4-week assessment, by 6 and 12 months, there was no long-term difference in pain relief between the 2 groups." Dr. Zips said that the difference in pain scores at 4 weeks was not statistically significant, and neither was the difference in patients who crossed over to the other therapy, but both showed a "statistical trend" in favor of radiotherapy.

He also noted the increased survival time in the patients who were treated with ibandronate followed by radiotherapy, and wondered if there "might be an interaction between ibandronate and radiotherapy that could be exploited and could be beneficial."

More work is needed, and more efforts need to be directed at this complication of painful bone metastases in cancer patients, because this is a "big problem, with a strong negative impact on quality of life and maybe survival." "We need more research on this," he emphasized.

This trial was funded by Roche, the manufacturer of ibandronate, as well as by Cancer Research UK and the UK National Cancer Research Network.

2011 European Multidisciplinary Cancer Congress (EMCC): Abstract 7LBA. Presented September 25, 2011.

Authors and Disclosures

Journalist

Zosia Chustecka

Zosia Chustecka is the News Editor for Medscape Oncology. A pharmacology graduate based in London, UK, she has edited and written extensively for publications aimed at clinician audiences. Winner of a 2011 Award for Excellence in Urology Health Reporting for an article on prostate cancer, her work also has been recognized by the British Medical Journalists Association, and recently she was awarded a Harvard University Fellowship on Cancer Genetics (May 2011) as well as a US National Press Foundation Cancer Issues Fellowship (October 2010). She can be reached at zchustecka@medscape.net.

Disclosure: Zosia Chustecka has disclosed no relevant financial relationships.

 


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