Abstract
Background
Radium-223 (223Ra) improves survival in patients with metastatic castration-resistant prostate cancer
(mCRPC). This retrospective analysis was performed to better understand its efficacy
in routine clinical practice and identify factors associated with survival.
Materials and Methods
Sixty-four patients with mCRPC who received 223Ra between 2013 and 2015 were the basis of this retrospective study. Clinical outcomes
and patient characteristics were obtained. Potential prognostic factors for survival
were evaluated by univariate analysis using the log-rank test and multivariate analysis
using the Cox proportional hazard method.
Results
The median survival was 12.9 months. Twenty-one patients (33%) developed a skeletal
event, and the median time to the first skeletal event was 4.4 months. In univariate
analysis, factors significantly associated with survival included: no prior chemotherapy, ≤
5 bone metastases, baseline prostate-specific antigen (PSA) ≤ 36 ng/mL, baseline alkaline
phosphatase (ALP) < 115 U/L, baseline hemoglobin > 12 g/dL, ALP response after 223Ra treatment, PSA decrease during 223Ra treatment, and absence of > 25% PSA increase during 223Ra treatment. In multivariate analysis, 4 factors remained significant: no prior chemotherapy, ≤
5 bone metastases, baseline ALP < 115 U/L, and ALP response after 223Ra treatment.
Conclusion
When 223Ra is administered in routine clinical practice, clinical outcomes can be more variable
than those reported in the randomized study owing to patient heterogeneity. Four factors
were identified to be significantly associated with survival after 223Ra treatment. These pretreatment factors may be used as stratification factors in
future studies to investigate whether 223Ra would be more effective for patients with newly diagnosed metastatic disease that
is sensitive to androgen deprivation therapy.
Keywords
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References
- Docetaxel and estramustine compared with mitoxantrone and prednisone for advanced refractory prostate cancer.N Engl J Med. 2004; 351: 1513-1520
- Docetaxel plus prednisone or mitoxantrone plus prednisone for advanced prostate cancer.N Engl J Med. 2004; 351: 1502-1512
- Alpha emitter radium-223 and survival in metastatic prostate cancer.N Engl J Med. 2013; 369: 213-223
- Patient-reported quality-of-life analysis of radium-223 dichloride from the phase III ALSYMPCA study.Ann Oncol. 2016; 27: 868-874
- Factors affecting (223)Ra therapy: clinical experience after 532 cycles from a single institution.Eur J Nucl Med Mol Imaging. 2016; 43: 8-20
- Prognostic factors in patients treated with 223Ra: the role of skeletal tumor burden on baseline 18F-fluoride PET/CT in predicting overall survival.J Nucl Med. 2015; 56: 1177-1184
- Radium-223 in heavily pretreated metastatic castrate-resistant prostate cancer.Clin Genitourin Cancer. 2016; 14: 373-380e2
- Efficacy and safety of radium-223 dichloride in patients with castration-resistant prostate cancer and symptomatic bone metastases, with or without previous docetaxel use: a prespecified subgroup analysis from the randomised, double-blind, phase 3 ALSYMPCA trial.Lancet Oncol. 2014; 15: 1397-1406
- Chemohormonal therapy in metastatic hormone-sensitive prostate cancer.N Engl J Med. 2015; 373: 737-746
- Addition of docetaxel, zoledronic acid, or both to first-line long-term hormone therapy in prostate cancer (STAMPEDE): survival results from an adaptive, multiarm, multistage, platform randomised controlled trial.Lancet. 2016; 387: 1163-1177
Article info
Publication history
Published online: April 25, 2017
Accepted:
April 14,
2017
Received in revised form:
April 7,
2017
Received:
February 27,
2017
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
