Optimal usage of radium-223 in metastatic castration-resistant prostate cancer

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.

Journal of the Formosan Medical Association = Taiwan yi zhi. 2017 Oct 16 [Epub]

Tai-Lung Cha, Tony Tong-Lin Wu, Nicholas John Vogelzang, Chao-Yuan Huang, Shu-Pin Huang, Chia-Chi Lin, Yen-Chuan Ou, See-Tong Pang, Daniel Heung-Yuan Shen, Wen-Jeng Wu, Wayne Yen-Hwa Chang

Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan., Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan., Medical Oncology Comprehensive Cancer Centers of Nevada, University of Nevada School of Medicine, Las Vegas, USA. Electronic address: ., Department of Urology, National Taiwan University Hospital, Taipei, Taiwan., Department of Urology, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan., Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan., Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan., Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan., Department of Nuclear Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan., Department of Urology, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan., Division of General Urology, Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Urology, National Yang-Ming University School of Medicine, Taipei, Taiwan. Electronic address: .

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