Controlling the pain related to bone metastases in patients with prostate cancer can be difficult. Researchers have now discovered a single dose of a bisphosphonate drug is as effective for pain relief as single-dose radiotherapy, the standard treatment for bone metastases, according to a large randomized phase 3 trial presented at the 2011 European Multidisciplinary Cancer Congress.*
Professor Peter Hoskin, consultant clinical oncologist at the Mount Vernon Cancer Centre, Northwood, UK, and Professor of Clinical Oncology at University College, London, led the study of 470 patients with primary prostate cancer and painful bone metastases. Study participants were randomized to receive either a single dose of radiation or a single intravenous infusion of the bisphosphonate ibandronate (IB). Patients reported their primary site of pain upon entering the trial, and then again at 4 weeks, 8 weeks, 12 weeks, 26 weeks, and 52 weeks after treatment.
By examining analgesic use via the WHO pain ladder and the Mercadante method, researchers measured pain levels at 4 and 12 weeks. Those patients whose pain had not responded to the first treatment at 4 weeks switched to the alternative therapy and received their second treatment no later than week 8.
“We found that using IB was as good as single-dose radiotherapy in controlling pain,” said Hoskin. “Although there were more patients in the IB group with worse Mercadante scores at 4 weeks who needed re-treatment, at 6 and 12 months there was no long-term difference in pain relief between the 2 groups.”
Patients reported few side effects. These included brief nausea and upset stomach if radiotherapy passed through the abdomen and flu-like symptoms with IB. Age, site of pain, prior treatment, and performance status of patients in the trial were all well balanced.
The median survival of the four groups was:
- 11.8 months (radiotherapy only),
- 11.4 months (IB only),
- 12.7 months (radiotherapy then IB), and
- 16.8 months (IB then radiotherapy)
“We hope to analyze these survival differences further in the hope that it can give us further pointers as to how and whether we should use a combination of treatments,” Hoskin said.
“It is important to stress that radiotherapy still has a crucial role to play and is a highly effective treatment for many cancer patients. For patients with solitary metastases, pathological fracture, where the bone breaks due to weakness, and neurological complications of bone metastases, it remains the treatment of choice. Our research adds to the arsenal of the many effective treatments now available, and we believe that the findings will also be applicable to other primary cancers that can lead to bone metastases, for example breast cancer, where they are very common,” he concluded.
*The 2011 European Multidisciplinary Cancer Congress is the 16th congress of the European CanCer Organisation (ECCO), the 36th congress of the European Society for Medical Oncology (ESMO) and the 30th congress of European Society for Therapeutic Radiology and Oncology (ESTRO).
Source: ECCO