Radium-223 for Treatment of Prostate Cancer

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Radium-223 was approved as a treatment for men with bone-metastatic castration-resistant prostate cancer (mCRPC) in May 2013, based on findings from the ALSYMPCA trial. In this study, the use of radium-223 was associated with significantly improved overall survival (OS) compared with placebo. An updated analysis found a median OS with radium-223 of 14.9 months versus 11.3 months with placebo (P < .001).

Along with being easy to administer, radium-223 is associated with low rates of adverse events and low myelosuppression rates. One of the biggest hurdles facing the widespread incorporation of radium-223 into clinical practice is securing radiopharmaceutical licensure, suggests Brian Mehlhaff, MD. For practices without a radiation oncologist or nuclear medicine specialist, Kenneth Kernen, MD, recommends utilizing a local hospital for the administration of radium-223. These larger systems can provide patients with access to the radiopharmaceutical.

Early identification of qualified patients for radium-223 is essential to accommodate full treatment and optimize overlapping therapy opportunities, Mehlhaff adds. Some evidence suggests that early therapy could be more efficacious in patients with a lower baseline PSAs, similar to what is seen with sipuleucel-T, Christopher Pieczonka, MD, suggests.

In closing, moderator Raoul S. Concepcion, MD, expresses hope that future research will illuminate strategies for combinations and sequencing in patients with mCRPC. These new approaches could include the identification of a blood- or urine-based biomarker that would ideally preempt the need for repeated biopsies, he hopes.

The field of prostate cancer has undergone a recent transformation, with an explosion of knowledge and application for diagnostics, prognostics, and therapeutics, suggests Neal D. Shore, MD. Research continues to explore ways to further improve outcomes, including the investigation of novel agents.