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A phase 2 study of high-activity 186Re-HEDP with autologous peripheral blood stem cell transplant in progressive hormone-refractory prostate cancer metastatic to bone

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Abstract

Purpose

We investigated the potential for improvement in disease control by use of autologous peripheral blood stem cell transplant (PBSCT) to permit administration of high activities of 186Re-hydroxyethylidene diphosphonate (HEDP) in patients with progressive hormone-refractory prostate cancer (HRPC).

Methods

Eligible patients had progressive HRPC metastatic to bone, good performance status and minimal soft tissue disease. Patients received 5,000 MBq of 186Re-HEDP i.v., followed 14 days later by PBSCT. Response was assessed using PSA, survival, pain scores and quality of life.

Results

Thirty-eight patients with a median age of 67 years (range 50–77) and a median PSA of 57 ng/ml (range 4–3,628) received a median activity of 4,978 MBq 186Re-HEDP (range 4,770–5,100 MBq). The most serious toxicity was short-lived grade 3 thrombocytopenia in 8 (21%) patients. The median survival of the group is 21 months (95%CI 18–24 months) with Kaplan-Meier estimated 1- and 2-year survival rates of 83% and 40% respectively. Thirty-one patients (81%, 95% CI 66–90%) had stable or reduced PSA levels 3 months post therapy while 11 (29%, 95% CI 15–49%) had PSA reductions of >50% lasting >4 weeks. Quality of life measures were stable or improved in 27 (66%) at 3 months.

Conclusion

We have shown that it is feasible and safe to deliver high-activity radioisotope therapy with PBSCT to men with metastatic HRPC. Response rates and survival data are encouraging; however, further research is needed to define optimal role of this treatment approach.

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Acknowledgements

This work was undertaken in The Royal Marsden NHS Trust, who received a proportion of its funding from the NHS Executive; the views expressed in this publication are those of the authors and not necessarily those of the NHS Executive. This work was supported by the Institute of Cancer Research, the Bob Champion Cancer Trust and Cancer Research UK Section of Radiotherapy.

This project was funded by a grant from the National Cancer Institute supported by NIH grant number CA86784-02.

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Authors and Affiliations

  1. Department of Oncology, Queen’s University Belfast/Belfast City Hospital, Lisburn Road,, Belfast, BT9 7AB, UK

    J. M. O’Sullivan

  2. Department of Computing, The Royal Marsden Foundation NHS Trust,, Sutton, Surrey, UK

    A. R. Norman

  3. Department of Physics, The Royal Marsden Foundation NHS Trust,, Sutton, Surrey, UK

    V. R. McCready, G. Flux & F. M. Buffa

  4. Bob Champion Unit, The Royal Marsden Foundation NHS Trust,, Sutton, Surrey, UK

    B. Johnson

  5. Academic Unit of Urology, The Royal Marsden Foundation NHS Trust,, Sutton, Surrey, UK

    J. Coffey, A. Horwich, R. A. Huddart, C. C. Parker & D. P. Dearnaley

  6. Department of Nuclear Medicine, The Royal Marsden Foundation NHS Trust,, Sutton, Surrey, UK

    G. Cook

  7. Department of Haematology, The Royal Marsden Foundation NHS Trust,, Sutton, Surrey, UK

    J. Treleaven

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  1. J. M. O’Sullivan
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  2. A. R. Norman
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Correspondence to J. M. O’Sullivan.

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O’Sullivan, J.M., Norman, A.R., McCready, V.R. et al. A phase 2 study of high-activity 186Re-HEDP with autologous peripheral blood stem cell transplant in progressive hormone-refractory prostate cancer metastatic to bone. Eur J Nucl Med Mol Imaging 33, 1055–1061 (2006). https://doi.org/10.1007/s00259-005-0010-5

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  • DOI: https://doi.org/10.1007/s00259-005-0010-5

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