Radium-223 and taxane chemotherapy each improve survival of patients with metastatic castration-resistant prostate cancer (mCRPC). Whether the radium-223-taxane sequence could extend survival without cumulative toxicity was explored.
The global, prospective, observational REASSURE study (NCT02141438) assessed real-world safety and effectiveness of radium-223 in patients with mCRPC. Using data from the prespecified second interim analysis (data cutoff, March 20, 2019), hematologic events and overall survival (OS) were evaluated in patients who were chemotherapy-naive at radium-223 initiation and subsequently received taxane chemotherapy starting ≤90 days ("immediate") or >90 days ("delayed") after the last radium-223 dose.
Following radium-223 therapy, 182 patients received docetaxel (172 [95%]) and/or cabazitaxel (44 [24%]); 34 patients (19%) received both. Seventy-three patients (40%) received immediate chemotherapy and 109 patients (60%) received delayed chemotherapy. Median time from last radium-223 dose to first taxane cycle was 3.6 months (range, 0.3-28.4). Median duration of first taxane was 3.7 months (range, 0-22.0). Fourteen patients (10 in the immediate and four in the delayed subgroup) had grade 3/4 hematologic events during taxane chemotherapy, including neutropenia in two patients in the delayed subgroup and thrombocytopenia in one patient in each subgroup. Median OS was 24.3 months from radium-223 initiation and 11.8 months from start of taxane therapy.
In real-world clinical practice settings, a heterogeneous population of patients who received sequential radium-223-taxane therapy had a low incidence of hematologic events, with a median survival of 1 year from taxane initiation. Thus, taxane chemotherapy is a feasible option for those who progress after radium-223.
ClinicalTrials.gov identifier NCT02141438.
Radium-223 and chemotherapy are treatment options for metastatic prostate cancer, which increase survival but may affect production of blood cells as a side effect. We wanted to know what would happen if patients received chemotherapy after radium-223. Among the 182 men treated with radium-223 who went on to receive chemotherapy, only two men had severe side effects affecting white blood cell production (neutropenia) during chemotherapy. On average, the 182 men lived for 2 years after starting radium-223 and 1 year after starting chemotherapy. In conclusion, patients may benefit from chemotherapy after radium-223 treatment without increasing the risk of side effects.
Cancer. 2024 Feb 10 [Epub ahead of print]
Celestia S Higano, Sabina Dizdarevic, John Logue, Timothy Richardson, Saby George, Igle de Jong, Jeffrey J Tomaszewski, Fred Saad, Kurt Miller, Jeffrey Meltzer, Per Sandström, Frank Verholen, Bertrand Tombal, Oliver Sartor
Department of Medicine, University of Washington and Fred Hutchinson Cancer Research Center, Seattle, Washington, USA., Department of Nuclear Medicine, University Hospital Sussex, NHS Foundation Trust, and Brighton and Sussex Medical School, University of Sussex and Brighton, Brighton, UK., Oncology Department Uro-Oncology Team, The Christie NHS Foundation Trust, Manchester, UK., Urology, GU Research Network - Wichita Urology Group, Wichita, Kansas, USA., Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York, USA., Department of Urology CB62, University Medical Center Groningen, Groningen, Netherlands., Urology, MD Anderson Cancer Center at Cooper, Camden, New Jersey, USA., University of Montreal Hospital Centre, Montreal, Quebec, Canada., Charité Universitätsmedizin Berlin, Clinic for Urology and University Clinic, Berlin, Germany., Bayer HealthCare Pharmaceuticals, Whippany, New York, USA., Bayer Pharmaceuticals A/S, Copenhagen, Denmark., Bayer Consumer Care AG, Basel, Switzerland., Division of Urology, IREC, University Hospital Saint-Luc, Brussels, Belgium., Tulane Cancer Center, Tulane University School of Medicine, New Orleans, Louisiana, USA.