AUA Adds Radium-223 to Treatment Guidelines for mCRPC

Deepak A. Kapoor, MD

The American Urological Association (AUA) has added recommendations for the use of radium-223 to its treatment guidelines for castration-resistant prostate cancer (CRPC), the organization announced May 14, during its annual meeting.

The CRPC guideline was released in 2013, and the amendments regarding radium-223 were added as part of the AUA’s ongoing review of the most recently published literature. The drug was not in the original 2013 guideline because it was not approved by the FDA in time for review and inclusion in the document, said Deepak A. Kapoor, MD, chairman and CEO of Integrated Medical Professionals, PLLC, in Melville, New York, and clinical associate professor of Urologic Surgery at the Icahn School of Medicine at Mount Sinai Hospital, in New York City. Radium-223 was approved by the FDA in July 2013.

“The AUA recognized that this is an important drug in the armamentarium of urologists who treat castrate-resistant prostate cancer, did an expedited literature review, and released an update to the guideline which allows for the use of radium-223 in patients with CRPC with symptomatic skeletal metastasis,” Kapoor said.

“We in New York have incorporated this into one of our clinical pathways for some months now, and have treated a number of patients with radium-223, and I can say that it’s an extremely effective form of therapy that has produced tremendous results. So, I applaud the AUA in taking the step in updating their guideline so rapidly.”

Radium-223 is the first alpha-emitting radiopharmaceutical approved by the FDA. In the ALSYMPCA trial, it demonstrated the ability to delay skeletal-related events and prolong survival in men with CRPC, symptomatic bone metastases, and no known visceral metastatic disease.

The full CRPC guideline, including new amendments, is available at www.auanet.org/education/guidelines/castration-resistant- prostate-cancer.cfm.

All AUA clinical practice guidance documents, including guidelines, best practices and white papers, are available online at www.AUAnet.org.

AUA Recommendations for the Use of Radium-223 in CRPC

Clinicians should offer radium-223 to patients with symptomatic, metastatic CRPC who have good performance status and have not taken docetaxel chemotherapy. These patients should have symptomatic bone metastases without known visceral disease.

In patients who share the same eligibility criteria but have poor performance status, physicians may offer radium-223 in select cases, specifically when the performance status is directly related to symptoms associated with bone metastases.

Patients in the same population who have good performance status and have received prior docetaxel can also be offered radium-223.