Effect of radium-223 dichloride (Ra-223) on hospitalisation: An analysis from the phase 3 randomised Alpharadin in Symptomatic Prostate Cancer Patients (ALSYMPCA) trial

Symptomatic skeletal events (SSEs) commonly occur in patients with bone metastases, often leading to hospitalisations and decreased quality-of-life. In the ALSYMPCA trial, radium-223 significantly improved overall survival (hazard ratio 0. 70, 95% confidence interval [CI] 0.58-0.83, P < 0.001) and prolonged time to first SSE (hazard ratio 0.66, 95% CI 0.52-0.83, P = 0.00037) and subsequent SSE (hazard ratio 0.65, 95% CI 0.51-0.83, P = 0.00039) versus placebo in patients with castration-resistant prostate cancer with symptomatic bone metastases and no known visceral metastases. Health care resource use (HCRU), including hospitalisation events and days, were prospectively collected in ALSYMPCA. We assessed health care resource use for the first 12 months post-randomisation. Significantly fewer radium-223 (218/589; 37.0%) versus placebo patients (133/292; 45.5%) had at least one hospitalisation event (P = 0.016). However, mean number of hospitalisation events per patient was similar (radium-223 0.69 versus placebo 0.79, P = 0.226), likely due to the significantly longer follow-up time for radium-223 (7.82 months versus 6.92 months for placebo; P < 0.001). There were significantly fewer hospitalisation days per patient for radium-223 (4.44 versus 6.68, respectively, P = 0.004). The reduction in hospitalisation days with radium-223 was observed both before first SSE (2.35 days versus 3.36 days, respectively) and after SSE (7.74 days versus 9.19 days, respectively). Our data suggest that this reduced hospital days along with the survival benefit and reduction in time to SSEs with radium-223 treatment may contribute to improvements in health-related quality-of-life in patients with castration-resistant prostate cancer with symptomatic bone metastases (ALSYMPCA ClinicalTrials.gov number, NCT00699751.).

European journal of cancer (Oxford, England : 1990). 2016 Jan 05 [Epub ahead of print]

Christopher Parker, Lin Zhan, Paul Cislo, Jonathan Reuning-Scherer, Nicholas J Vogelzang, Sten Nilsson, Oliver Sartor, Joe M O'Sullivan, Robert E Coleman

The Royal Marsden Hospital, Downs Road, Sutton, Surrey, SM2 5PT, UK. Electronic address: ., Bayer HealthCare Pharmaceuticals, 100 Bayer Boulevard, Whippany, NJ 07981, USA., Yale University, New Haven, CT 06520, USA., Comprehensive Cancer Center of Nevada, 3730 South Eastern Avenue, Las Vegas, NV 89169, USA., Karolinska University Hospital, SE-171 76, Stockholm, Sweden., Tulane Cancer Center, 150 South Liberty Street, New Orleans, LA 70112, USA., Centre for Cancer Research and Cell Biology, Queen's University, Belfast, UK., Weston Park Hospital, Sheffield, UK.