title: Radionuclide Therapies in Prostate Cancer: Integrating Radium-223 in the Treatment of Patients With Metastatic Castration-Resistant Prostate Cancer.
abstract: Metastatic castration-resistant prostate cancer (mCRPC) frequently metastasizes to the bone, often resulting in painful skeletal events, reduced quality of life, and reduced survival. The beta-emitting radiopharmaceuticals strontium-89 and samarium-153 alleviated pain in mCRPC patients with widespread skeletal metastases and have been associated with myelotoxicity. Radium-223, a first-in-class alpha-emitting radiopharmaceutical, prolonged overall survival, delayed symptomatic skeletal events, and improved quality of life, versus placebo, in patients with CRPC and symptomatic bone metastases and no visceral metastases. Radium-223 provided survival benefit to patients with CRPC and symptomatic bone metastases, regardless of prior docetaxel use. Importantly, prostate-specific antigen level and pain palliation were not a measure of radium-223 treatment response and should not alter the decision to administer all six radium-223 injections, the recommended regimen for survival benefit. Radium-223 was generally well tolerated, leading to ongoing clinical trials in combination with other therapeutics. Thus, radium-223 is a valuable addition to the mCRPC treatment armamentarium.
authors.affiliation: Department of Oncology-Pathology, Karolinska University Hospital, Karolinska Institutet, SE-17177, Solna, Sweden. sten.nilsson@ki.se.
authors.forename: Sten
authors.initials: S
authors.lastname: Nilsson
mesh_terms: D050071:Bone Density Conservation Agents / Q000008:administration & dosage*; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy* / Q000556:secondary; D018450:Disease Progression; D006801:Humans; D008297:Male; D059408:Pain Management; D017410:Practice Guidelines as Topic; D064129:Prostatic Neoplasms, Castration-Resistant / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy*; D011788:Quality of Life; D016499:Radioimmunotherapy; D019275:Radiopharmaceuticals / Q000008:administration & dosage*; D014057:Tomography, X-Ray Computed
chemical_list: D050071:Bone Density Conservation Agents; D019275:Radiopharmaceuticals
keywords: Abiraterone; Alpha emitters; Beta emitters; Bone metastases; Castration-resistant prostate cancer; Docetaxel; Enzalutamide; Overall survival; Pain; Quality of life; Radionuclide; Radium-223 dichloride; Samarium-153; Strontium-89; Symptomatic skeletal events