Radium-223 (Ra-223) dichloride is the bone-targeted radioligand therapy that prolongs overall survival (OS) in patients with bone-metastatic castration-resistant prostate cancer (CRPC). We aimed to evaluate the safety and effectiveness of this treatment in real-world practice.
We included Japanese men treated with Ra-223 for bone-metastatic CRPC from 10 institutions, retrospectively. Primary endpoint was OS. Secondary endpoint was maximum decline of alkaline phosphatase (ALP), lactate dehydrogenase, and prostate-specific antigen values, the rate of adverse events, and time to pathological fracture after Ra-223 treatment. Exploratory endpoint was the associations between clinical parameters and OS.
In total, 73 men with bone metastatic CRPC treated with Ra-223 were enrolled. The median OS was 20.9 months. ALP levels decreased significantly from pre-treatment (p = 0.03). Anemia occurred in three (4.1%) patients. Grade ≥ 3 non-pathological fractures occurred in four (5.5%) men. Nine (12.3%) patients presented pathological fracture; 7/30 (23.3%) were in men without concomitant use of a bone-modifying agent (BMA) while 2/43 (4.7%) were in patients with concomitant BMA (p = 0.03). The median OS in patients with ≥3 cycles treatment (27.2 months, p < 0.001) or hemoglobin ≥12 g/dl (27.2 months, p = 0.001) or absence of bone pain (36.3 months, p = 0.004) was significantly longer compared to those who with ≤2 cycles or hemoglobin<12 g/dl or presence of bone paint, respectively.
This study has shown the outcomes of Ra-223 treatment in real-world practice, where the number of treatment cycles, baseline anemia and bone pain may be useful to predict OS in Ra-223 treatment.
International journal of urology : official journal of the Japanese Urological Association. 2022 Oct 28 [Epub ahead of print]
Takashi Matsumoto, Yoshifumi Hori, Masaki Shiota, Leandro Blas, Motonobu Nakamura, Narihito Seki, Kentaro Kuroiwa, Akira Yokomizo, Futoshi Morokuma, Keijiro Kiyoshima, Masatoshi Eto
Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan., Department of Urology, Miyazaki Prefectural Miyazaki Hospital, Miyazaki, Japan., Department of Urology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan., Department of Urology, Kyushu Central Hospital, Fukuoka, Japan., Department of Urology, Harasanshin Hospital, Fukuoka, Japan., Department of Urology, Saga-ken Medical Centre Koseikan, Saga, Japan., Department of Urology, Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan.