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This is a combination therapy consisting of three agents used in the management of bone metastases and associated pain in cancer patients: - **Samarium-153** (typically administered as samarium Sm 153 lexidronam) is a radiopharmaceutical that emits beta particles and selectively targets areas of increased bone turnover, such as osteoblastic bone metastases. It provides palliative relief from bone pain by delivering localized radiation to metastatic lesions[2]. - **Strontium-89** (administered as strontium chloride Sr-89) is another radiopharmaceutical that mimics calcium and localizes to areas of active bone formation, delivering beta radiation for palliation of painful skeletal metastases[4]. - **Zoledronic acid** is a potent bisphosphonate that inhibits osteoclast-mediated bone resorption, reducing skeletal-related events (SREs) such as fractures or spinal cord compression in patients with metastatic cancer involving the bones[1]. The combination has been studied primarily for palliative care in patients with metastatic castration-resistant prostate cancer and other cancers with bony metastases. Clinical trials have evaluated the safety and efficacy of combining these agents to control pain and reduce SREs[1][5][6]. The rationale for combining them lies in their complementary mechanisms—radiopharmaceuticals provide targeted radiation-induced tumor cell death within the skeleton while zoledronic acid reduces pathological bone remodeling.
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