BoneKEy Reports | BoneKEy Watch

Radium-223 therapy for metastatic prostate cancer



DOI:10.1038/bonekey.2013.186

This phase 3 study of 921 men with castration-resistant prostate cancer and metastatic bone cancer looked at the impact of treatment with radium-223 dichloride (radium-223) on overall survival.

Radium-223 is an alpha particle emitter that specifically targets metastases in bone. It was administered as a monthly injection (50 kBq per kg body weight) to two-thirds of participants, while the remaining third received a placebo injection. Patients who had been treated with docetaxel, who had declined docetaxel or for whom it was not suitable/available were all included.

Analysis of the 921 patients showed that those who received radium-223 survived for a median of 14.9 months, while the patients receiving placebo injections survived for a median of 11.2 months. This represents a hazard ratio of 0.70 (95% confidence interval 0.58–0.83; P=0.001).

Radium-223 treatment reduced time to first symptomatic skeletal event, time to rise in the level of total alkaline phosphatase and time to rise in prostate-specific antigen level. The rate of adverse events in the treated group was lower than in the control group; this included fewer grade 3–4 events (56% vs 62%) and serious adverse events (47% vs 60%). Only 16% of radium-223-treated patients discontinued therapy due to adverse events, compared with 21% of the placebo group.

Editor’s comment: The clinical findings reported by Parker et al. are very encouraging. They strongly suggest that radium-223 dichloride could be a potential new standard of care for castration-resistant prostate cancer with bone metastases.


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