Radium-223 (Ra-223) therapy provides a survival benefit for castration-resistant prostate cancer (CRPC) patients with bone metastasis. The optimal timing of using Ra-223 has not been determined. We evaluated the efficacy and safety of Ra-223 before and after docetaxel (DOC) therapy.
We retrospectively reviewed 36 CRPC patients with bone metastasis who were treated with Ra-223 in our institution and satellite hospitals. Ra-223 was used before DOC (pre-DOC group) in 17 patients (47%) and after DOC (post-DOC group) in 19 patients (53%). The treatment completion rate of 6 cycles, progression-free survival (PFS), cause-specific survival (CSS) and occurrence rate of adverse events were compared between the groups.
The median follow-up duration was 45 months. In the pre-DOC compared with the post-DOC group, treatment completion rate was significantly higher (94% vs. 52%, p<0.01), PFS was significantly longer (median: 8 vs. 5 months, p=0.024) and CSS was significantly longer (median: 32 vs. 15 months, p=0.028). The difference in CSS was significant in multivariate analysis. In the pre-DOC compared with the post-DOC group, the occurrence rate of grade ≥3 adverse events tended to be lower (6% vs. 36%, p=0.322), and the CSS tended to be longer (median: not reached vs. 45 months, p=0.208).
Ra-223 could be used more safely and more effectively for CRPC patients with bone metastasis before than after DOC therapy.
Anticancer research. 2022 Oct [Epub]
K O Okabe, Naoki Terada, Tatsuya Shirakawa, Chie Onizuka, Tomoya Kimura, Yasuhiro Yamashita, Isamu Otuka, Takashi Ueno, Masafumi Nagano, Hiroki Takamori, Shoichiro Mukai, Toshiyuki Kamoto
Department of Urology, Sapporo Medical University, School of Medicine, Sapporo, Japan; ., Department of Urology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan., Department of Urology, Nichinan Prefectural Hospital, Nichinan, Japan., Department of Urology, Nobeoka Prefectural Hospital, Nobeoka, Japan., Department of Urology, Fujimoto General Hospital, Miyakonojo, Japan.