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    Bone supportive therapy increases likelihood of pain palliation

    Administering bone supportive therapy (BST) within 1 month prior to starting radium Ra 223 dichloride (Xofigo) may increase the likelihood of achieving pain palliation with the radionuclide therapy and reduce the chance of pain flare, according to the findings of a retrospective study presented at the American Society of Clinical Oncology annual meeting in Chicago.

    The research, conducted by investigators from the University of Southern California, Los Angeles, and Mayo Clinic, Phoenix, AZ, identified 65 men treated with Ra 223, of whom 22 (34%) received BST with either denosumab (Xgeva) or zoledronic acid (Zometa) within 1 month prior to Ra 223. Pain palliation and flare after starting Ra 223 were analyzed using pain severity data scored on a 0 to 10 scale.

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    Fourteen men (six on BST and eight not on BST) were evaluable for pain palliation based on having a pain score >0 prior to starting Ra 223 and data from at least one subsequent pain score with information on pain medication use. Pain response (palliation), defined as a ≥2 point decrease after starting Ra 223 without increased pain medication use, was achieved by all six men who started BST within 1 month prior to Ra 223. Among the eight men who were not on BST, only four (50%) achieved pain palliation, and three (37.5%) experienced pain progression defined as worsening of the pain score.

    The analysis of pain flare included 34 men who had pain score data available prior to starting Ra 223 and from at least two subsequent visits. Flare, defined as a ≥2 point increase followed by a return to baseline or lower, occurred in two (15%) of 13 patients on BST and in six (29%) of 21 patients not on BST.

    “We were interested in investigating the impact of the timing of BST administration on pain palliation in men receiving Ra 223 because a previously published study showed that administering zoledronic acid 48 to 72 hours prior to samarium-153 resulted in faster and better pain relief. In addition, we wanted to investigate if BST had potential benefit for mitigating pain flare that can occur in up to 30% of patients starting on Ra 223,” said Kelly Yap, MD, of the University of Southern California.

    Next: "We believe the findings support the administration of BST up to 1 month before initiating treatment with Ra 223, assuming there are no contraindications to BST"

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