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Radium 223 combined with new hormone therapies for the treatment of castrate-resistant metastatic prostate cancer: scientific evidence and sharing of our experience.

ABSTRACT: Presentation of the interesting case of a patient suffering from castrate-resistant prostate cancer (CRPC) with bone metastasis, who received concomitant treatment with abiraterone acetate (AA) and radium-223. The patient experienced significant clinical improvement in his quality of life and pain relief after beginning the aforementioned treatment, without being affected by adverse toxicities. Currently, the correct selection of patients to receive radium-223 treatment is still a clinical challenge in the case of CRPC with metastasis. In this article, we discuss the future prospects of this treatment, reviewing current evidence about concomitant therapies with radium-223 and its present state, based upon the recent recommendations from the Pharmacovigilance Risk Assessment Committee (PRAC), and the data presented in the ERA-223 study. Based on our clinical experience, we provide practical orientation for the integration of this radiopharmaceutical in the therapeutic plan for this group of patients. We conclude, despite some of the positive results and our excellent experience, that it would be wise to wait for the results of the clinical trials that are studying the safety and benefits of the combined use of radium-223 with new hormone therapies. Bearing in mind that to date, the only published large-scale randomised trial that investigated the combination of AR-axis-targeted therapy with Ra-223 is negative, the harms of the combination outweighed any benefits in ERA-223. Nonetheless, in order to recommend whether or not this treatment should be used, it is essential to define the patient profile that could benefit from this therapeutic option.

SUBMITTER: Jimenez-Romero ME

PROVIDER: S-EPMC6842784 | biostudies-literature | 2019 Oct

REPOSITORIES: biostudies-literature

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Radium 223 combined with new hormone therapies for the treatment of castrate-resistant metastatic prostate cancer: scientific evidence and sharing of our experience.

Jiménez-Romero Miguel E ME Canelón-Castillo Elba Y EY Díez-Farto Sara S Santotoribio Jose D JD

Translational andrology and urology 20191001 5

Presentation of the interesting case of a patient suffering from castrate-resistant prostate cancer (CRPC) with bone metastasis, who received concomitant treatment with abiraterone acetate (AA) and radium-223. The patient experienced significant clinical improvement in his quality of life and pain relief after beginning the aforementioned treatment, without being affected by adverse toxicities. Currently, the correct selection of patients to receive radium-223 treatment is still a clinical chall ...[more]

PMID: 31807434

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Project description:BACKGROUND:Hormone-refractory breast cancer metastatic to bone is a clinically challenging disease associated with high morbidity, poor prognosis, and impaired quality of life owing to pain and skeletal-related events. In a preclinical study using a mouse model of breast cancer and bone metastases, Ra-223 dichloride was incorporated into bone matrix and inhibited proliferation of breast cancer cells and differentiation of osteoblasts and osteoclasts (all P values?<?.001) in vitro. Ra-223 dichloride also induced double-strand DNA breaks in cancer cells in vivo. METHODS:The US Food and Drug Administration recently approved radium-223 (Ra-223) dichloride (Ra-223; Xofigo injection) alpha-particle therapy for the treatment of symptomatic bone metastases in patients with castration-resistant prostate cancer. On the basis of a strong preclinical rationale, we used Ra-223 dichloride to treat bone metastases in a patient with breast cancer. RESULTS:A 44-year-old white woman with metastatic breast cancer who was estrogen receptor-positive, BRCA1-negative, BRCA2-negative, PIK3CA mutation (p.His1047Arg) positive presented with diffuse bony metastases and bone pain. She had hormone refractory and chemotherapy refractory breast cancer. After Ra-223 therapy initiation her bone pain improved, with corresponding decrease in tumor markers and mixed response in (18)F-FDG PET/CT and (18)F-NaF bone PET/CT. The patient derived clinical benefit from therapy. CONCLUSION:We have shown that Ra-223 dichloride can be safely administered in a patient with hormone-refractory bone metastasis from breast cancer at the US FDA-approved dose for prostate cancer. Furthermore, because the treatment did not cause any drop in hematologic parameters, it has the potential to be combined with other radiosensitizing therapies, which may include chemotherapy or targeted therapies. Given that Ra-223 dichloride is already commercially available, this case report may help future patients and provide a rationale for initiating clinical research in the use of Ra-223 dichloride to treat bone metastasis from breast cancer. A randomized clinical trial is needed to provide evidence of efficacy, safety, and good outcomes.

Dataset Information

Radium 223 combined with new hormone therapies for the treatment of castrate-resistant metastatic prostate cancer: scientific evidence and sharing of our experience.

Publications

Radium 223 combined with new hormone therapies for the treatment of castrate-resistant metastatic prostate cancer: scientific evidence and sharing of our experience.

Similar Datasets

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