Upwards of 90 percent of patients with breast, prostate and lung cancer develop bone metastases at some point while battling their disease, according to an article in Pain Medicine News. And with that development comes unbearable, often unrelenting pain as the cancer spreads into the bone marrow.

While standard of care usually means using opioids, which provide relief by dulling the brain, non-opioid alternatives for cancer exist — and they pose fewer side effects, last longer and, in some cases, are more effective than their opioid counterparts.

While standard of care usually means using opioids, which provide relief by dulling the brain, non-opioid alternatives for cancer exist…

One such treatment, Strontium-89 Chloride, is an injectable non-opioid radiopharmaceutical for bone pain from metastasized cancer, and can offer benefits lasting several months as opposed to morphine’s effect of only a few hours, says Dr. Stanley Satz, co-founder of Bio-Nucleonics, Inc. and a developer of the drug.

“Patients see relief in one to two weeks that can last up to six months,” Satz says, “and they don’t have the side effects of opioids.”

How non-opioid cancer treatment works

After an intravenous injection, Strontium-89 behaves like calcium, moving quickly from the blood and selectively localizing in the bone and preferentially in sites of active growth and bone formation; the primary bone tumors and areas of metastatic involvement (blastic lesions) can accumulate significantly greater concentrations of strontium than surrounding normal bone.

Strontium-89 is retained in metastatic bone lesions much longer than in normal bone, where it selectively irradiates sites of primary and metastatic bone involvement with minimal effect on soft tissues distant from the bone lesions.

David Laskow-Pooley, vice president of product development at Q BioMed Inc., the specialty pharmaceutical company that has licensed and is commercializing Strontium-89, says, “When Strontium-89 is injected, the bone rapidly absorbs the drug. It releases its energy over a very small distance, which envelops the cancer with very little of the adjacent tissue being affected. It is this energy that removes the pain and indeed where damage to cancer cells have been observed,” he says.

Other benefits of choosing opioid alternatives

Satz says Strontium-89, which is FDA approved and Medicare reimbursed, provides benefits beyond those of other non-opioid solutions, such as thermal radiation, as this treatment isn’t appropriate if cancer has spread throughout the body. “Thermal radiation is good for a single lesion, but not if you have multiple metastases where Strontium-89 Chloride injection is a better treatment option.”

“Opioid therapy is not only addictive but also severely adversely affects the patient’s quality of life mentally and physically,” Pooley says. “Additionally, opioids depress the activity of a large number of organs in the body. These not only affect body function in the short term but can lead to consequential and catastrophic problems, severely impacting quality of life in the later stages of disease progression.”

In clinical trials, the number of patients classified at each visit as treatment successes (patients who were pain free at the index site and required no analgesics) was consistently higher in the Strontium-89 group and new pain sites were less frequent in patients treated with Strontium-89.

The United States faces an increasingly dire opioid abuse epidemic, with tens of thousands of drug overdoses reported overall in 2016, according to the Centers for Disease Control and Prevention. In this context, non-opioid solutions in cancer care serve a timely and valuable purpose.

IMPORTANT SAFETY INFORMATION

NDICATIONS AND USAGE

STRONTIUM CHLORIDE Sr-89 INJECTION, USP is indicated for the relief of bone pain in patients with painful skeletal metastases.

The presence of bone metastases should be confirmed prior to therapy.

CONTRAINDICATIONS

None known.

WARNINGS

Use of Strontium-89 Chloride Injection in patients with evidence of seriously compromised bone marrow from previous therapy or disease infiltration is not recommended unless the potential benefit of the treatment outweighs its risks. Bone marrow toxicity is to be expected following the administration of Strontium-89, particularly white blood cells and platelets. The extent of toxicity is variable. It is recommended that the patient’s peripheral blood cell counts be monitored at least once every other week. Typically, platelets will be depressed by about 30% compared to pre-administration levels. The nadir of platelet depression in most patients is found between 12 and 16 weeks following administration of Strontium-89 Chloride Injection. White blood cells are usually depressed to a varying extent compared to pre-administration levels. Thereafter, recovery occurs slowly, typically reaching pre-administration levels six months after treatment unless the patient's disease or additional therapy intervenes.

In considering repeat administration of Strontium-89 Chloride Injection, the patient’s hematologic response to the initial dose, current platelet level and other evidence of marrow depletion should be carefully evaluated.

Verification of dose and patient identification is necessary prior to administration because Strontium-89 delivers a relatively high dose of radioactivity.