There are a number of studies in patients with bone metastases which have combined a beta-emitting radiopharmaceutical, usually Sr-89, with a variety of che-motherapeutic drugs, including gemcitabine, estramustine, mitoxantrone, paclitaxel, carboplatin, cisplatin, and doxorubicin, with only a very few truly controlled for response with or without the radiopharmaceutical. Some of these have been used in combination, as with Sr-89, estramustine, and vinblastine. The response rates in these studies have ranged from 55% to 80%, a range seen in multiple investigations that did not include chemotherapeutic agents.
Sr-89 followed by carboplatin yielded superior pain relief compared with Sr-89 in one study, with no difference in survival. In a study of hormone refractory prostate cancer with painful bone metastases, induction therapy with ketoco-nonazole, doxorubicin, estramustine, and vinblastine was followed by randomization to receive doxorubicin with or without subsequent Sr-89. The median survival time for the combination was 27.7 months and for doxorubicin alone was 16.8 months. If confirmed, this would be one of the first studies showing that a beta-emitting radiopharmaceutical conveyed a survival advantage. On the other hand, the addition of Sr-89 to gemcitabine in painful prostate cancer metastatic to bone yielded no response at all.
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