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What is Quadramet?

Quadramet is an FDA-approved radiopharmaceutical used for relief of pain in patients who have been confirmed to have metastatic bone lesions that can be seen on bone scans. In less technical language, Quadramet combines radiation with a drug that targets and attacks cancer cells in the bone. It is prescribed for patients that have bone pain resulting from cancer spreading to the bones (bone metastases). Quadramet is given by injection into a vein, usually as an outpatient procedure.

Quadramet has helped over 25,000 patients since it was approved by the FDA more than 10 years ago.11

Quadramet is different from some other radiopharmaceuticals used to treat bone metastasis pain in three ways.
 * First, the half-life of Quadramet is less than 2 days.2 Half-life refers to the amount of time it takes for a radioactive substance to break down by half. This means that with Quadramet the radiation is out of your system quickly.
 * Second, with Quadramet your dose will be determined by your weight. With other products, the dose may be universally applied to patients whether they weigh 100 pounds or 250 pounds.
 * Third, for those who respond to Quadramet, pain relief may take effect quickly - within 1 week of injection. The greatest pain relief will usually happen 3 to 4 weeks after treatment.2

Reduce Bone Pain from Metastatic Cancer with Quadramet®

If you or someone you care for suffers from bone pain as a result of metastic cancer, you may be interested in learning more about bone pain and how to address it. This article is written specifically for patients and caregivers, so they can educate themselves about bone metastases, bone pain and some of the treatment options currently available.

In this article, you will also learn about the benefits of Quadramet® (Samarium Sm 153 Lexidronam Injection) in reducing bone pain, including safety considerations and risks. Quadramet is an FDA-approved injection used for relief of pain in certain patients who have been confirmed to have metastatic bone lesions (cancer spreading to the bones) that can be seen on bone scans.

Indication: Quadramet is indicated for relief of pain in patients with confirmed osteoblastic metastatic bone lesions that enhance on radonuclide bone scan.

About Quadramet®: Could It Be Right for Your Bone Pain?

When you or someone you care for is in pain, it can be challenging to tackle the rigors of cancer treatment. Bone pain doesn't have to deprive you or your loved one of mobility and quality of life while in cancer treatment. Your healthcare team can manage bone pain, as they treat the primary cancer.

A healthcare provider may have informed you about Quadramet® (Samarium Sm 153 Lexidronam Injection) which is used to reduce bone pain from cancer that has spread into the bones. Here you can learn more about Quadramet, how it can help, its side effects and safety considerations.

Learn More about Bone Metastases, Bone Pain and Treatments

What are Bone Metastases?

Cancer cells can spread from their original site to other parts of the body. These new areas are called metastatic sites and the process is called metastasis. Metastases occur when cancer cells split from the primary tumor and travel through the bloodstream or lymphatic system and become fixed to other organs of the body creating secondary tumors. When cancer spreads to the bones it is called bone metastases (bone mets). So, bone metastasis is when cancer spreads from an original location to a secondary location in the bone. This is not the same as bone cancer (sarcoma), which has the bone itself as the original location of the cancer.

Some cancers are more likely to spread to the bone than others, such as prostate, breast, and lung cancer, as well as multiple myeloma.4 Bone mets tend to occur most often in the limbs, pelvis, rib cage, spine and skull. These secondary tumors can lead to fragile bones that break or fracture easily, as the tumor destroys small areas of bone creating osteolytic lesions. It is also common for bone mets to stimulate abnormal bone build up - called osteoblastic lesions. These lesions can be painful and they also weaken the bone - again increasing the risk of bones that fracture or break. Typically when cancer spreads to the bones, both osteolytic lesions (bone erosion) and osteoblastic lesions (abnormal bone build-up) are present.

The most common symptom of bone metastases is bone pain. But not all bone pain is caused by metastases and not all bone metastases are painful. Your healthcare provider will determine the cause of bone pain and decide on the proper treatment5 after testing (typically bone scans). Your bone pain may come and go at first, then become more consistent and perhaps grow stronger over time if left untreated. At first, some people find the pain may be more intense at night or when resting.5 While for others, there is more pain when they move.6

The Importance of Treating Pain from Bone Metastases

As you undergo treatment for cancer, your healthcare team's focus is on treatment of the primary cancer. But they are also interested in managing related health issues - like pain. Be sure to talk to your healthcare provider about your bone pain. Managing bone pain is important so that you can feel as strong and as comfortable as possible. Keep talking about your pain as it changes so that your healthcare team can advise you. Managing pain is a process. Additional or different pain treatments may be needed over time.

Many patients worry that if they talk about their pain, this might cause their healthcare provider to take a less aggressive approach in treating the cancer. Rest assured that this is not the case; you do not have to trade treatment of cancer for treatment of the pain. It is important to talk about your pain openly and without minimizing it. If you can no longer do the things you once did without pain - like walk the dog, climb the stairs, sleep comfortably - then it's time to talk about your pain. Your healthcare team's goal is to treat your cancer and also manage your bone pain. In fact, one clinical trial has shown that patients whose pain was well controlled actually lived longer and with a better quality of life.8

Treatment Options

The most common treatments for cancer-related bone complications include: analgesics (pain medicines), external beam radiation, bisphosphonates and radiopharmaceuticals. Quadramet® (Samarium Sm 135 Lexidronam Injection) is an FDA-approved radiopharmaceutical prescribed for patients that have bone pain resulting from cancer spreading to the bones.
 * Analgesics: Sometimes nonsteroidal anti-inflammatory drugs (NSAIDs), such as acetaminophen and ibuprofen, are enough to manage the pain. When these aren't enough, morphine or morphine-like drugs (sometimes called opioid analgesics) may be added. Opioid analgesics can be addictive and may have significant side effects that include dizziness, lightheadedness, drowsiness, nausea, vomiting, constipation, diarrhea and loss of appetite.7
 * External Beam Radiation: For bone pain limited to a few locations, your healthcare providers may use external beam radiation. Even in patients whose tumors cannot be contained, radiation can shrink cancer growth enough to reduce pain. Radiation treatment of bone metastases usually takes 2 to 3 weeks of daily treatments. Radiation therapy is typically not used when bone pain is in multiple locations because it can damage normal cells.9
 * Bisphosphonates: Bisphosphonates are drugs that are used to reduce and delay bone complications in cancer patients. They help increase bone mass reducing the possibility of fracture. Although some patients experience bone pain relief when they take bisphosphonates, these drugs have not been approved by the FDA specifically for bone pain reduction.
 * Radiopharmaceuticals: Radiopharmaceuticals are drugs that contain radioactive materials that target and kill cancer cells. They are used to deliver radiation therapy to multiple areas of bone metastases at the same time. A radiopharmaceutical combines radiation with a drug that targets bone and is administered through an injection. After it is injected, the drug carries most of the radiation to the areas of the bone where the cancer has spread. The rest of the medication not in the bone, including radiation, is washed out of the body.

References


 * 1) Serafini AN, Houston SJ, Resche I, et al. Palliation of pain associated with metastatic bone cancer using samarium-153 lexidronam: a double-blind placebo-controlled clinical trial. J Clin Oncol. 1998;16:1574-1581.
 * 2) Quadramet (samarium Sm-153 lexidronam injection) prescribing information. April 2009.
 * 3) Sartor O, Reid RH, Hoskin PJ, et al. Samarium-153-Lexidronam complex for treatment of painful bone metastases in hormone-refractory prostate cancer. Urology. 2004;63:940-945.
 * 4) National Cancer Institute. Fact Sheet: Metastatic Cancer: Reviewed May 23, 2011. Available at: http://www.cancer.gov/cancertopics/factsheet/Sites-Types/metastatic. Accessed August 15, 2011.
 * 5) The Cancer Information Network. NCI Booklet: Dealing With Bone Metastasis. Available at: http://thecancer.net/article.php?id=28&cate1=Types%20of%20Cancer&cate2=Metastatic%20Cancer&cate3=Bone%20Metastasis. Accessed August 15, 2011.
 * 6) Mercadante S, Villari P, Ferrera P, Casuccio A. Optimization of opioid therapy for preventing incident pain associated with bone metastases. J Pain Symptom Manage. 2004;28:505-510.
 * 7) National Library of Medicine. Morphine Oral. What side effects can this medicine cause? Available at: http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a682133.html. Accessed August 15, 2011.
 * 8) Temel J, Greer J, Muzikansky A, et al. Early Palliative Care for Patients with Metastatic Non-Small-Cell Lung Cancer. N Engl J Med. 2010;363:733-42.
 * 9) Deng H, et al. Radiopharmaceutical (Sm-153-EDTMP) therapy of skeletal metastases: clinical application in 350 patients. The Journal of Radiology, 2002.
 * 10) Sartor O, Reid RH, Bushnell DL, Quick DP, Ell PJ. Safety and efficacy of repeat administration of samarium Sm-153 lexidronam to patients with metastatic bone pain. Cancer. 2007;109:637-643.
 * 11) Distribution data on file EUSA Pharma (USA), Inc Langhorne PA. 35,000 vials have been distributed since the launch of Quadramet; the data have not been adjusted for actual number of patients treated, number of vials used for calibration, or number of returns.