¹⁸⁸Re-HEDP therapy in the therapy of painful bone metastases

For bone-targeted radionuclide therapy (BTRT), different commercial radiopharmaceuticals are available such as strontium-89, ¹⁸⁶Rhenium-hydroxyethylidene diphosphonate (¹⁸⁶Re-HEDP), Samarium-153-ethylenediamine tetramethylene phosphonic acid, and radium-223. Unfortunately, the commercial available radiopharmaceuticals are very expensive (from 1,200 to 36,000€ per patient in Europe). The ¹⁸⁸W/¹⁸⁸Re generator is an ideal source for the long-term (4-6 months) continuous availability of ¹⁸⁸Re suitable for the preparation of radiopharmaceuticals for different radionuclide therapies. Labeling at HEDP, it can use cost-effective for BTRT, if enough patients are available for therapy. And so, ¹⁸⁸Re-HEDP is the ideal candidate in developing countries which high population to replace the other agents. Two German groups documented a response rate of 80% without any severe side effects and similar bone marrow toxicity compared to the other compounds for ¹⁸⁸Re-HEDP. Using ¹⁸⁸Re-HEDP in repeated treatments, a prolonged overall survival of repeated to single application was observed (from 4.5 months for single to 15.7 months using ≥≥3 applications).