Radium-223 dichloride (Ra-223) is recommended as a treatment option for metastatic castration-resistant prostate cancer (mCRPC) patients with symptomatic bone metastases and no visceral disease, after docetaxel failure, or in patients who are not candidates to receive it. In this study, we aimed to ambispectively analyze overall survival (OS) and prognostic features in mCRPC in patients receiving Ra-223 as per clinical routine practice and identify the most suitable treatment sequence.
This study is observational, multicentric, and ambispective. Eligibility criteria included mCRPC patients treated with Ra-223, with an Eastern Cooperative Oncology Group (ECOG) performance status of 0-2, without visceral metastases, and no more than three cm involved lymph nodes.
A total of 145 patients were included; the median age was 73.97 years, and a Gleason score of more than or equal to 7 in 61 (48%) patients; 73 (81%) had previously received docetaxel. The most important benefit was reached by those patients who received Ra-223 in the second-line setting, with a median OS of 17 months (95% CI, 12-21), and by patients who received six cycles of treatment, with a median OS of 19 months (95% CI, 14-21). An alkaline phosphatase (ALP) decrease was also identified as a prognosis marker. When performing the multivariate analysis, the time to develop castration-resistant disease longer than 24 months was the most important prognostic factor to predict the evolution of the patients receiving Ra-223. Ra-223 was well tolerated, with thrombocytopenia, anemia, and diarrhea being the main adverse events.
There is a benefit for those patients who received Ra-223 in the second-line setting, regardless of prior use of docetaxel. In addition, a survival benefit for patients presenting with a decline in ALP was observed.
Frontiers in oncology. 2024 May 07*** epublish ***
Urbano Anido-Herranz, Ovidio Fernandez-Calvo, Juan Ruiz-Bañobre, Sara Martinez-Breijo, Natalia Fernandez-Nuñez, Zulema Nogareda-Seoane, Miguel Garrido-Pumar, Javier Casas-Nebra, Gloria Muñiz-Garcia, Paula Portela-Pereira, Antonio Gomez-Caamaño, Daniel Adolfo Perez-Fentes, Lucia Santome-Couto, Martín Lázaro, Aurea Molina-Diaz, Ana Medina-Colmenero, Sergio Vazquez-Estevez
Translational Medical Oncology Group (ONCOMET), Health Research Institute of Santiago de Compostela (IDIS), University Clinical Hospital of Santiago de Compostela, University of Santiago de Compostela (USC), Santiago de Compostela, Spain., Department of Medical Oncology, University Clinical Hospital of Ourense, Ourense, Spain., Department of Urology, University Clinical Hospital of A Coruña, A Coruña, Spain., Department of Medical Oncology, Lucus Augusti University Hospital, Lugo, Spain., Department of Nuclear Medicine, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain., Department of Urology, Lucus Augusti University Hospital, Lugo, Spain., Department of Nuclear Medicine - GALARIA, Complexo Hospitalario Universitario Ourense A. S. de Ourense, Ourense, Spain., Department of Urology, Area Sanitaria de Ourense, Ourense, Spain., Department of Radiation Oncology, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain., Department of Urology, EOXI University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain., Department of Medical Oncology, POVISA, Vigo, Spain., Department of Medical Oncology, Álvaro Cunqueiro Hospital, Vigo, Spain., Department of Medical Oncology, University Clinical Hospital of A Coruña, A Coruña, Spain., Department of Medical Oncology, Fundación Centro Oncológico de Galicia, A Coruña, Spain.