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JOURNAL ARTICLE

223 Ra-chloride therapy in men with hormone-refractory prostate cancer and skeletal metastases: Real-world experience

Giuseppe Boni, Sara Mazzarri, Claudia Cianci, Luca Galli, Azzurra Farnesi, Eugenio Borsatti, Roberto Bortolus, Lucia Fratino, Carlo Gobitti, Elda Lamaj, Pietro Ghedini, Elisa Lodi Rizzini, Francesco Massari, Valeria Dionisi, Stefano Fanti, Duccio Volterrani, Fabio Monari
Tumori 2018, 104 (2): 128-136
29714668

BACKGROUND: Radium-223 (223 Ra) chloride, an alpha emitter, has been shown to improve overall survival (OS) and pain control, and to delay skeletal-related events, in patients with castration-resistant prostate cancer (CRPC) and bone metastases. Our retrospective observational study presents the first Italian experience on the efficacy and safety of 223 Ra therapy in routine clinical practice.

METHODS: A total of 83 patients with metastatic CRPC were treated with 223 Ra at 3 Italian centers between August 2013 and August 2016. 223 Ra-chloride (55 kBq/kg) was administered every 4 weeks for a total of 6 cycles. Primary endpoints were OS and progression-free survival (PFS). Secondary endpoints included toxicity, pain evaluation using numeric rating scale (NRS), symptomatic skeletal-related events and biomarkers response.

RESULTS: Patients had a median age of 75 (range 53-89) years. The majority of men showed a Gleason score of 7, 8, or 9. Forty-one patients completed 6 treatment cycles; 33 stopped treatment before completing 6 cycles. Nine were still receiving therapy at the time of data collection. At the end of therapy, NRS pain scores significantly improved ( p < .000001). OS was a mean of 10.1 months, while median OS had not been attained. According to Kaplan-Meier estimation, OS and PFS were 17.5 and 7.7 months, respectively. There was a significant correlation between OS and PFS with the number of 223 Ra cycles; patients receiving all 6 cycles experienced the major benefit from the therapy. 223 Ra was well-tolerated.

CONCLUSIONS: 223 Ra alpha therapy is an important therapeutic option for men with CRPC and symptomatic skeletal metastases.

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