In spite of significant progress in the diagnosis and management of solid
tumors, the incidence of bone metastasis is still high, and the use of bone-targeted
agents does not prevent the development of their complications such a skeletal related
events. While the most current bone targeting medications act on the bone microenvironment
and the osteolytic bone metastasis. The beta-emitters radiopharmaceuticals
such as Samarium-153-ethylene diamine tetramethylene phosphonate and
Sm-153 oxabifore target osteoblastic bone lesions by irradiating nerve fibers that
innervate the skeleton and cancer cells which may lead to the termination of growth
factorsthat stimulates cancer cell dissemination to the skeleton.
However, their role usually is limited by palliative treatment for painful bone
metastases. Recently it is demonstrated that the combination of radionuclide therapy
with bisphosphonates or chemotherapy is potentially more effective as compared to use
in isolation. The synergetic approach of bone metastasis therapy is perspective;
however, chemotherapy is generally contraindicated in combination with radionuclide
therapy due to possible synergetic myelotoxicity. Vertebral fracture and impending
cord compression are other contraindications for radionuclide therapy.
In this book chapter, we presented possible combined/complex therapy approach
including best timing of radionuclide/bisphosphonate administration, combined therapy
with monoclonal antibody Denosumab its effectiveness and metabolic response,
radionuclide therapy in combination with percutaneous vertebroplasty, possibility to
use Sm-153 therapy in combination with bisphosphonates, hormonal therapy,
chemotherapy and targeted therapy in breast cancer patients, side effects, survival rate
and incidence of SRE in patients who received combined/complex therapy and the
possibility to use of lactate dehydrogenase level as an indicator of disease progression.
Keywords: Beta Emitter, Bisphosphonates, Bone Metastases, Breast Cancer, Combined Therapy, Complex Therapy, Chemotherapy, Denosumab, Hormonal Therapy, Impeding Cord Compression, Lactate Dehydrogenase, Monoclonal Antibody, Percutaneous Vertebroplasty, Prostate Cancer, Samarium-153-ethylene Diamine Tetramethylene Phosphonate (153Sm-EDTMP), Sm-153 Oxabifore, Skeletal related events, Survival Rate, Vertebral Fracture, Vicious Circle.