Pain relief for bone metastasis in prostate cancer

This study compared the effectiveness of ibandronate (Boniva) with the more conventional radiotherapy in reducing metastatic bone pain in prostate cancer.

Bone metastasis (cancer spread to the bone) is a common and painful occurrence in prostate cancer. There are a range of treatments available, with radiotherapy being the standard and most effective treatment used to date. Ibandronate is a new generation of bisphosphonates, a class of drugs that slow or stop the natural process that dissolves bone tissue. Some evidence has shown that ibandronate can help reduce bone pain associated with bone metastases. There has been no previous direct comparison, however, between radiotherapy and bisphosphonates for pain relief from bone metastases.

The study involved 470 prostate cancer patients with metastatic bone pain. The patients were randomly assigned to receive a single dose of either local radiotherapy or ibandronate. Pain responses were measured before and 4, 8, 12, 26 and 52 weeks after the intervention. Pain scores were determined using two pain classification surveys Quality of life was assessed at baseline and at 4 and 12 weeks.

There was no significant overall difference in pain scores between radiotherapy and ibandronate. After 4 weeks, up to 52.7% of patients responded to ibandronate treatment compared with up to 60.2% of patients responding to radiotherapy. This remained largely unchanged at 12 weeks and at long-term assessment. Quality of life over time and survival rates were also similar between ibandronate and radiotherapy.

Patients receiving radiotherapy were more likely to experience diarrhea (12%) compared to patients receiving ibandronate (6%). Nausea was also more common in the radiotherapy group. Patients in the ibandronate group, however, were more likely to experience effects such as fever or loss of appetite.

The authors concluded that a single dose of ibandronate had similar outcomes in terms of pain relief to a single dose of radiotherapy for metastatic bone pain in prostate cancer patients.

Roughly one quarter of patients who did not respond to their original treatment crossed over to the other treatment after 4 weeks. Those retreated patients were 33% more likely to survive the duration of the study. This means that there may be an effect from the retreatment alone.

Discuss your pain management options with your physician.