Radium-223 dichloride (radium-223) was approved for the treatment of patients with castration-resistant prostate cancer (CRPC) and symptomatic bone metastases in the United States and Europe in 2013. This followed a reported overall survival benefit for patients treated with radium-223 and best standard of care (BSoC) when compared with placebo and BSoC in the ALpharadin in SYMptomatic Prostate CAncer (ALSYMPCA) trial. At that time, docetaxel was the standard first-line choice for patients with metastatic CRPC (mCRPC). Since then, the treatment landscape has changed dramatically with new hormonal agents (abiraterone and enzalutamide) considered to be the first-line choice for many patients. The optimal patient profile for radium-223 in the modern setting, and its best use either in sequence or in combination with other approved agents are unclear, with few definitive guidelines available. This article reports on the views of a group of urologists and medical oncologists experienced in treating patients with mCRPC with radium-223 in routine clinical practice. The aim is to provide an overview of the current use of radium-223 in the treatment of patients with mCRPC, and to discuss best practices for patient selection and on-treatment monitoring. Where agreement was reached, guidance on the optimal use of radium-223 is provided.
Clinical genitourinary cancer. 2017 Sep 06 [Epub ahead of print]
Daniel Heinrich, Jasmin Bektic, Andries M Bergman, Orazio Caffo, Richard Cathomas, Kim N Chi, Gedske Daugaard, Daniel Keizman, Jon Kindblom, Gero Kramer, David Olmos, Aurelius Omlin, Srikala S Sridhar, Marcello Tucci, Inge van Oort, Sten Nilsson
Department of Oncology, Akershus University Hospital, Lørenskog, Norway. Electronic address: ., Department of Urology, Medical University Innsbruck, Innsbruck, Austria., Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands., Medical Oncology Department, Santa Chiara Hospital, Trento, Italy., Department of Oncology and Hematology, Kantonsspital Graubünden, Chur, Switzerland., Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, Canada., Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark., Genitourinary Oncology Service, Department of Oncology, Meir Medical Center, Kfar Saba, Israel; Affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel., Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden., Department of Urology, Medical University of Vienna, Vienna, Austria., Medical Oncology Department, CNIO-IBIMA Genito-Urinary Cancer Unit, Hospitales Universitarios Virgen de la Victoria y Regional de Málaga, Málaga, Spain; Prostate Cancer Unit, Spanish National Cancer Research Centre, Madrid, Spain., Department of Oncology and Haematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland; Department of Oncology and Haematology, University Hospital Berne, Berne, Switzerland., Department of Medical Oncology and Hematology, Princess Margaret Cancer Center, Toronto, Canada., Department of Oncology, Medical Oncology, University of Turin at San Luigi Hospital, Orbassano, Italy., Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands., Department of Oncology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden.