Optimal usage of radium-223 in metastatic castration-resistant prostate cancer
Journal
Journal of the Formosan Medical Association
Journal Volume
116
Journal Issue
11
Pages
825-836
Date Issued
2017
Author(s)
Cha T.-L.
Wu T.T.-L.
Vogelzang N.J.
Huang S.-P.
Ou Y.-C.
Pang S.-T.
Shen D.H.-Y.
Wu W.-J.
Chang W.Y.-H.
Abstract
Radium-223 is a first-in-class α-emitting radiopharmaceutical that targets bone metastases associated with metastatic castration-resistant prostate cancer (mCRPC). In the pivotal phase III trial ALSYMPCA, radium-223 significantly increased overall survival (OS), compared with placebo (median 14.9 vs 11.3 months; hazard ratio 0.70; 95% CI 0.58–0.83; p < 0.001), in patients with mCRPC and symptomatic bone metastases–with a comparable safety profile. To optimize treatment outcomes, selection of appropriate patients is important. As well as osteoblastic bone metastases, mCRPC patients should be well enough to receive six doses of radium-223 as this treatment duration has been shown to greatly improve OS outcomes compared with administration of four or fewer doses. Additionally, alkaline phosphatase and lactate dehydrogenase are emerging as important biomarkers during radium-223 treatment. Optimal concomitant standard-of-care therapies (such as abiraterone or enzalutamide) to be administered with radium-223 have yet to be defined as does the most efficacious dose and duration of radium-223 treatment. In conclusion, radium-223 is an important addition to the mCRPC treatment landscape and marks a paradigm shift in the treatment of bone metastases. ? 2017
SDGs
Other Subjects
abiraterone; abiraterone acetate; alkaline phosphatase; biological marker; enzalutamide; lactate dehydrogenase; radium chloride ra 223; radiopharmaceutical agent; radium; Radium-223; anemia; aplastic anemia; backache; bone marrow suppression; bone metastasis; bone pain; cancer survival; castration resistant prostate cancer; diarrhea; drug efficacy; drug safety; fatigue; fever; follow up; hot flush; human; hypertension; liver toxicity; neutropenia; osteoblast; overall survival; patient selection; phase 1 clinical trial (topic); phase 2 clinical trial (topic); phase 3 clinical trial (topic); Review; seizure; spinal cord compression; systematic review; thrombocytopenia; treatment duration; treatment outcome; bone tumor; castration resistant prostate cancer; clinical trial (topic); male; pathology; secondary; Bone Neoplasms; Clinical Trials as Topic; Humans; Male; Prostatic Neoplasms, Castration-Resistant; Radiopharmaceuticals; Radium; Treatment Outcome
Publisher
Elsevier B.V.
Type
review