The results of the phase 3 ALSYMPCA trial showed that Radium-223 (Ra-223) improves overall survival (OS) and delays onset of first symptomatic skeletal event vs. placebo in patients with metastatic castration-resistant prostate cancer (mCRPC). The purpose of the REACTIVATE study was to inform the optimal placement of Ra-233 in the treatment sequence by evaluating clinical outcomes and healthcare resource utilization using real-world data from multiple Canadian provinces.
This retrospective cohort study analyzed patient outcomes according to Ra-223 placement using administrative databases of four Canadian provinces, encompassing 4301 patients with mCRPC who received at least two lines of life-prolonging therapy (LPT) for mCRPC. Outcomes included OS, event-free survival (EFS), and healthcare resource utilization. Each province was analyzed separately.
OS, measured from the start of second-line LPT, differed between provinces: those in Ontario receiving second-line Ra-223 had a longer OS vs. those receiving it in third-line or later (hazard ratio [HR] 0.79, 95% confidence interval [CI] 0.66-0.95). There was no difference between lines of therapy in patients in British Columbia (HR 1.165, 95% CI, 0.894-1.518, p=0.2576), and OS was numerically worse but not statistically significant in patients receiving Ra-223 in second-line in Quebec (HR 1.44, 95% CI, 0.93-2.24). Other outcomes also varied across provinces, with second-line use of Ra-223 being associated with longer EFS and reduced healthcare utilization vs. third-line use in Ontario but not in Quebec.
Significant heterogeneity exists in the management and outcomes of mCRPC between provinces, particularly regarding the placement of Ra-223 in the treatment sequence.
Canadian Urological Association journal = Journal de l'Association des urologues du Canada. 2024 Mar 01 [Epub ahead of print]
Jenny J Ko, Lawrence Mbuagbaw, Scott Tyldesley, Jennifer Lowther, Katherine Sunderland, Catherine Royer, Mareva Faure, Corin MacPhail, Shoaib Faizi, Winson Y Cheung, Richard Lee-Ying
Department of Medical Oncology, University of British Columbia, BC Cance-Abbotsford, Abbotsford, BC, Canada., Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada., Department of Radiation Oncology, BC Cancer-Vancouver, Vancouver, BC, Canada., Medical Affairs, Bayer Inc., Mississauga, ON, Canada., Division of Cancer Surveillance and Outcomes, BC Cancer, Vancouver, BC, Canada., PeriPharm Inc., Montréal, QC, Canada., Department of Pediatrics, University of Alberta, Edmonton, AB, Canada., Vancouver Fraser Medical Program, University of British Columbia, Vancouver, BC, Canada., Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.