Universität zu Köln

Parker, Chris, Heidenreich, Axel, Nilsson, Sten and Shore, Neal (2018). Current approaches to incorporation of radium-223 in clinical practice. Prostate Cancer Prostatic Dis., 21 (1). S. 37 - 48. LONDON: NATURE PUBLISHING GROUP. ISSN 1476-5608

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Abstract

Background Treatment options for metastatic castration-resistant prostate cancer (mCRPC) have expanded in recent years and include cytotoxic agents (e.g., docetaxel and cabazitaxel), immunotherapy (e.g., sipuleucel-T), oral hormonal therapies targeting the androgen receptor axis (e.g., enzalutamide and abiraterone), and targeted alpha therapy (e.g., radium-223 dichloride (radium-223)). Although treatment guidelines have been updated to reflect the availability of new agents, it is not easy to apply them in daily clinical practice because recommendations vary depending on patient comorbidities and disease characteristics. Furthermore, therapeutic accessibility, clinical judgment, and experience affect the selection of treatment options. Methods In this review, we provide practical guidance for the integration of radium-223 into the management of patients with mCRPC based on our collective clinical experience, as well as the available clinical trial data. Results Radium-223 is a targeted alpha therapy; as a bone-seeking calcium mimetic, it accumulates in hydroxyapatite areas surrounding tumor lesions and selectively binds to the areas of increased bone turnover. Radium-223 prolongs overall survival and delays time to the first symptomatic skeletal events in men with mCRPC, and is indicated for the treatment of patients with CRPC, symptomatic bone metastases, and no known visceral metastases. We review its clinical efficacy and safety, practical guidance on identifying the appropriate patient, and recommendations for how best to educate and inform prospective patients regarding their treatment decision making. In addition, we review recent evidence for sequential and combination therapies with radium-223, provide our experiences with these treatment approaches, and discuss their implications for the future treatment of patients with mCRPC. Conclusions Based on our clinical experience, radium-223 should be considered relatively early in the treatment course in patients with mCRPC with bone metastases. Coordination of care among multidisciplinary team members, patients, and caregivers is essential for optimizing safe and effective treatment with all CRPC therapies.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Parker, Chris UNSPECIFIED UNSPECIFIED UNSPECIFIED Heidenreich, Axel UNSPECIFIED UNSPECIFIED UNSPECIFIED Nilsson, Sten UNSPECIFIED UNSPECIFIED UNSPECIFIED Shore, Neal UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-191255
DOI:	10.1038/s41391-017-0020-y
Journal or Publication Title:	Prostate Cancer Prostatic Dis.
Volume:	21
Number:	1
Page Range:	S. 37 - 48
Date:	2018
Publisher:	NATURE PUBLISHING GROUP
Place of Publication:	LONDON
ISSN:	1476-5608
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language RESISTANT PROSTATE-CANCER; BONE METASTASES; DOUBLE-BLIND; ABIRATERONE ACETATE; INCREASED SURVIVAL; EMITTING RA-223; PLUS PREDNISONE; OPEN-LABEL; DOCETAXEL; DICHLORIDE Multiple languages Oncology; Urology & Nephrology Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/19125