Answer to Question #1205 Submitted to "Ask the Experts"

Q

I am interested in learning all I can about rhenium-186 for pain palliation for metastatic cancer in the bone. Is it Food and Drug Administration approved yet? Are there side effects? Can treatment be repeated? How long does it take before relief begins and when it does, how long will it last?

A

Rhenium-186 (HEDP) is not Food and Drug Administration (FDA) approved, and I don't even know whether Mallinckrodt Medical is still pursuing it. There are two other FDA-approved drugs available, ⁸⁹Sr Chloride (Metastron, Nycomed-Amersham) and ¹⁵³Sm-EDTMP (Quadramet, Berlex Laboratories). The April 2000 issue (volume 41) of the Journal of Nuclear Medicine has several useful and comprehensive articles on the subject of radiopharmaceutical therapy for bone metastases; I would recommend that you peruse these articles and use the references for further information.

If you or a member of your family is a candidate for one of these drugs, your nuclear medicine physician should give you more personalized information. If your physician doctor won't or can't answer your questions, you should insist on a different physician. Both Metastron and Quadramet are about $3,000/dose—which is expensive—and numerous managed-care plans therefore don't like to use it. You should check with your medical insurance plan for coverage.

Carol Marcus, MD

Editor's Note: Further can be found at the National Library of Medicine website by searching for Metastron and Quadramet.