Targeted Radionuclide Therapy of Painful Bone Metastases: Past Developments, Current Status, Recent Advances and Future Directions
Bone pain arising from secondary skeletal malignancy constitutes one of the most
common types of chronic pain among patients with cancer which can lead to rapid deterioration
of the quality of life. Radionuclide therapy using bone-seeking radiopharmaceuticals
based on the concept of localization of the agent at bone metastases sites to deliver focal cytotoxic
levels of radiation emerged as an effective treatment modality for the palliation of symptomatic
bone metastases. Bone-seeking radiopharmaceuticals not only provide palliative
benefit but also improve clinical outcomes in terms of overall and progression-free survival.
There is a steadily expanding list of therapeutic radionuclides that are used or can potentially be
used in either ionic form or in combination with carrier molecules for the management of bone
metastases. This article offers a narrative review of the armamentarium of bone-targeting radiopharmaceuticals
based on currently approved investigational and potentially useful radionuclides
and examines their efficacy for the treatment of painful skeletal metastases. In addition,
the article also highlights the processes, opportunities, and challenges involved in the
development of bone-seeking radiopharmaceuticals. Radium-223 is the first agent in this class
to show an overall survival advantage in castration-resistant prostate cancer (CRPC) patients
with bone metastases. This review summarizes recent advances, current clinical practice using
radiopharmaceuticals for bone pain palliation, and the expected future prospects in this field.
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Radiopharmaceuticals Division, Bhabha Atomic Research Centre, Trombay, Mumbai-400085, India.
Homi Bhabha National Institute, Anushaktinagar, Mumbai-400094, India.
Medical Isotopes Program, Isotope Development Group, MS 6229, Bldg. 4501, Oak Ridge National Laboratory, PO Box 2008, 1 Bethel Valley Road, Oak Ridge, TN, 37831, USA.
Appeared or available online: March 15, 2019