title: Clinical Correlates of Benefit From Radium-223 Therapy in Metastatic Castration Resistant Prostate Cancer.
abstract: We sought to identify potential clinical variables associated with outcomes after radium-223 therapy in routine practice.
  
  
  
  Consecutive non-trial mCRPC patients who received ≥1 dose of radium dichloride-223 at four academic and one community urology-specific cancer centers from May 2013 to June 2014 were retrospectively identified. Association of baseline and on-therapy clinical variables with number of radium doses received and clinical outcomes including overall survival were analyzed using chi-square statistics, cox proportional hazards, and Kaplan-Meier methods. Bone Scan Index (BSI) was derived from available bone scans using EXINI software.
  
  
  
  One hundred and forty-five patients were included. Radium-223 was administered for six cycles in 74 patients (51%). One-year survival in this heavily pre-treated population was 64% (95%CI: 54-73%). In univariate and multivariate analysis, survival was highly associated with receiving all six doses of Radium-223. Receipt of six doses was associated with ECOG PS of 0-1, lower baseline PSA & pain level, no prior abiraterone/enzalutamide, <5 BSI value, and normal alkaline phosphatase. In patients who reported baseline pain (n = 72), pain declined in 51% after one dose and increased in 7%. PSA declined ≥50% in 16% (18/110). Alkaline phosphatase declined ≥25% in 48% (33/69) and ≥50% in 16/69 patients. BSI declined in 17 (68%) of the 25 patients who had bone scan available at treatment follow-up. Grade ≥3 neutropenia, anemia, and thrombocytopenia occurred in 4% (n = 114), 4% (n = 125), and 5% (n = 123), respectively.
  
  
  
  Patients earlier in their disease course with <5 BSI, low pain score, and good ECOG performance status are optimal candidates for radium-223. Radium-223 therapy is well tolerated with most patients reporting declines in pain scores and BSI. Prostate 77:479-488, 2017. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Division of Hematology/Oncology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Ajjai
authors.initials: A
authors.lastname: Alva
authors.affiliation: Urology Cancer Center and GU Research Network, Omaha, Nebraska.
authors.forename: Luke
authors.initials: L
authors.lastname: Nordquist
authors.affiliation: Division of Hematology/Oncology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Daignault
authors.affiliation: Roswell Park Cancer Institute, Buffalo, New York.
authors.forename: Saby
authors.initials: S
authors.lastname: George
authors.affiliation: Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: Jorge
authors.initials: J
authors.lastname: Ramos
authors.affiliation: Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, Indiana.
authors.forename: Costantine
authors.initials: C
authors.lastname: Albany
authors.affiliation: Urology Cancer Center and GU Research Network, Omaha, Nebraska.
authors.forename: Sudhir
authors.initials: S
authors.lastname: Isharwal
authors.affiliation: Urology Cancer Center and GU Research Network, Omaha, Nebraska.
authors.forename: Matthew
authors.initials: M
authors.lastname: McDonald
authors.affiliation: Division of Hematology/Oncology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Gregory
authors.initials: G
authors.lastname: Campbell
authors.affiliation: Roswell Park Cancer Institute, Buffalo, New York.
authors.forename: Pongwut
authors.initials: P
authors.lastname: Danchaivijitr
authors.affiliation: Division of Hematology/Oncology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Sarah
authors.initials: S
authors.lastname: Yentz
authors.affiliation: Department of Translational Medicine, Urological Cancer, Lund University, Lund, Sweden.
authors.forename: Aseem
authors.initials: A
authors.lastname: Anand
authors.affiliation: Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: Evan Y
authors.initials: EY
authors.lastname: Yu
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D015331:Cohort Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D064129:Prostatic Neoplasms, Castration-Resistant / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality; D011868:Radioisotopes / Q000008:administration & dosage; D011883:Radium / Q000008:administration & dosage*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends
chemical_list: D000970:Antineoplastic Agents; D011868:Radioisotopes; C581106:radium Ra 223 dichloride; D011883:Radium
keywords: Bone Scan Index; outcomes; variables