In my years of clinical practice, patients with bone metastases from lung cancer often seek medical advice because of unbearable pain. This pain is not only a physical pain, but also a psychological pressure. For example, a middle-aged male patient once came to my clinic with back pain. At first, I thought it was ordinary muscle pain, but after conventional treatment, the pain did not decrease but increased. After further examination, the diagnosis of advanced bone metastases of lung cancer was confirmed.
This patient's case is not unusual. Lung cancer is often in the middle and advanced stages at the time of diagnosis due to its strong insidious nature and inconspicuous early symptoms, and bone metastasis is one of the common metastatic routes. Pain is often the patient's initial complaint and is one of the most important factors affecting quality of life. In the face of such patients, how to effectively relieve pain and improve their quality of life is a major challenge for our doctors.
Medication regimen 1: bisphosphonates
Introduction and Mechanism of Action:
Bisphosphonates are a class of drugs commonly used in the treatment of bone metastasis in lung cancer, mainly by inhibiting bone resorption to reduce pain in diseased bones. These drugs can directly act on osteoporotic sites and inhibit the activity of osteoclasts, thereby reducing further bone destruction and effectively relieving bone pain caused by bone metastasis.
Specific drug selection:
Commonly used bisphosphonates include isomeric phosphates (Zoledronic acid) and alendronate. Among them, isomeric phosphate is widely used in clinical practice because of its strong anti-bone resorption ability.
How to Apply:
Form and dosage: Isomeric phosphate is usually given as an intravenous infusion of 4 mg every 3 to 4 weeks. Alendronate is taken orally, one tablet daily, or a fortified dose once a week.
Duration of treatment: Treatment is generally recommended to be started as soon as possible after the diagnosis of bone metastases, and the duration depends on the change in disease and patient tolerance, and long-term treatment is usually required to maintain the effect.
Notes:
Renal function monitoring: Patients need to be monitored for kidney function before and after the use of bisphosphonates to prevent drug-induced kidney damage.
Risk of calcemia: Patients should have their blood calcium levels checked regularly while using these drugs to avoid hypocalcemia.
Oral hygiene: Patients should maintain good oral hygiene during treatment to avoid the side effects of osteonecrosis, especially those undergoing dental procedures.
Clinical Results:
In practice, bisphosphonates can significantly reduce pain levels and improve quality of life, while reducing the risk of fractures and other osteoporosis-related complications due to bone metastases. In addition, the rational use of bisphosphonates can prolong the asymptomatic survival of patients and is an important part of the treatment of patients with bone metastases of lung cancer.
Medication regimen 2: radiopharmaceuticals
Introduction and Mechanism of Action:
Radiopharmaceutical therapy, also known as radionuclide therapy, is another effective treatment modality for bone metastases in lung cancer. These drugs inhibit the growth of cancer cells and reduce pain by introducing radioisotopes into the body that directly target the site of bone metastases, thereby damaging the DNA of cancer cells. Radiopharmaceuticals are mainly used in patients whose pain is difficult to control or who do not respond well to other treatments.
Specific drug selection:
Commonly used radiopharmaceuticals include Samarium-153 and Strontium-89. The choice of these agents depends on the patient's specific condition and the extent of pre-existing bone damage.
How to Apply:
Form and dosage: Samarium-153 is usually given intravenously at a dosage of approximately 37 MBq (1 mCi) per kilogram of body weight, based on the patient's body weight. Samarium-89 was given at an active dose of 148 MBq (4 mCi) and was administered intravenously.
Treatment period: The interval between treatment for samarium-153 and samarium-89 is usually 3-4 months, depending on the patient's symptom improvement and side effects.
Notes:
Hematological surveillance: Routine blood tests are done regularly before and after treatment with radiopharmaceuticals to monitor for possible bone marrow suppression.
Radiation protection: During treatment, patients and their families should take appropriate radiation protection measures to avoid unnecessary radiation exposure.
Hydration treatment: Patients should increase their water intake before and after treatment to help remove radioactive materials quickly from the body and reduce side effects on the body.
Clinical Results:
The clinical application of radiopharmaceuticals has shown that they are effective in relieving pain caused by bone metastases from lung cancer, especially for patients who do not respond to conventional pain treatments. In addition, this treatment can also locally control the progression of the tumor and reduce the occurrence of complications such as fractures. However, patients should use these drugs under close supervision by their physicians to ensure maximum safety and effectiveness.
Through the use of radiopharmaceuticals, it can provide an effective means of pain management and disease control for patients with bone metastasis of lung cancer. Rational drug selection and use strategies, coupled with rigorous monitoring and care, can enable patients to achieve a better quality of life and longer survival when facing the challenge of bone metastases from lung cancer.
Medication regimen 3: narcotic analgesics
Introduction and Mechanism of Action:
Narcotic analgesics, also known as opioids, are commonly used to control severe pain in patients with bone metastases from lung cancer. These drugs work by mimicking the effects of natural opioids (endorphins) in the brain and binding to opioid receptors in the brain and spinal cord, thereby inhibiting the transmission of pain signals and achieving analgesic effects.
Specific drug selection:
Morphine: Suitable for persistent and severe pain control, it is the gold standard for evaluating and treating cancer pain.
Fentanyl: 80-100 times more potent than morphine, often used for rapid control of pain breakouts (i.e., sudden intensification of pain).
Oxycodone: 5 times more potent than morphine, indicated in patients who do not respond well to other opioids.
How to Apply:
Drug form and dosage:
Morphine: may be given orally, subcutaneously, or intravenously, usually 10-30 mg initially every 4 hours, adjusted according to pain severity.
Fentanyl: The most common form is a skin patch, which is changed every 72 hours depending on the pain level, and the dose is adjusted starting at 12.5 mcg/hour.
oxycodone: may be taken orally or injected, usually 2.5 to 7.5 mg every 3 to 4 hours initially, adjust according to pain.
Treatment Cycle:
Use continuously, with regular dose adjustments based on the patient's pain level and drug tolerance.
Notes:
Dependence and tolerance: Long-term use of opioids may lead to increased physical dependence and tolerance, and dose adjustments should be titrated under the guidance of a physician.
Side effect management: Common side effects include constipation, nausea, vomiting and respiratory depression, and these side effects should be prevented and controlled in advance.
Control of breakthrough pain: for sudden exacerbations, rapid-acting opioids should be prepared to control pain quickly.
Clinical Results:
In practical application, narcotic analgesics can effectively control moderate to severe pain caused by bone metastasis of lung cancer and significantly improve the quality of life of patients. The correct use of these drugs can enable patients to maintain a better lifestyle during treatment and reduce the psychological and physical burden caused by pain.
Through this medication regimen, we can not only provide patients with painful relief, but also ensure that the side effects are effectively controlled while the patient receives the treatment, ensuring the safety and comfort of the treatment through precise dose adjustment. During use, the patient's response should be closely monitored, and the treatment strategy should be adjusted in time to cope with pain changes and possible drug side effects.