Open Access

ARTICLE

Practical guide to the use of radium 223 dichloride

Robert B. Den^1,2,3, Laura A. Doyle², Karen E. Knudsen^1,2,3,4

1 Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
2 Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
3 Department of Cancer Biology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
4 Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
Address correspondence to Dr. Robert B. Den, Department of Radiation Oncology, Thomas Jefferson University Hospital, 111 South 11th Street, Philadelphia, PA 19107-5097 USA

Canadian Journal of Urology 2014, 21(Suppl.2), 70-76.

Abstract

instruction: Introduction: Bone-seeking radiopharmaceuticals have been used for decades in the palliation of pain from bone metastases emerging from prostate cancer. Recent clinical evidence has demonstrated an improved survival in men with metastatic castration-resistant prostate cancer (CRPC) with radium-223.
instruction: Materials and methods: A review of the literature was performed to identify the role of radiopharmaceuticals in the management of prostate cancer. We focused on prospective trials in order to identify the highest level of evidence describing this therapy. Further, we focused on providing a clinical guide for the use of radium-223.
instruction: Results: The phase III ALSYMPCA trial which compared radium-223 to placebo in men with symptomatic CRPC demonstrated a statistically significant improvement in median overall survival of 3.6 months and an improvement in time to first skeletal-related event. There were higher rates of myelosuppression and diarrhea with radium-223, however, no clinically meaningful differences in the frequency of grade 3 or 4 adverse events were observed between the study groups.
instruction: Conclusion: Radium-223 is a safe and effective therapy in men with symptomatic CRPC providing a survival advantage on par with novel antiandrogens, CYP-17 inhibitors, and chemotherapy. Radium-223 has huge potential in combination strategies as well as for use earlier in the natural history of metastatic prostate cancer.

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Keywords

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