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Prostate. 2017 Apr;77(5):479-488. doi: 10.1002/pros.23286. Epub 2016 Dec 19.

Clinical Correlates of Benefit From Radium-223 Therapy in Metastatic Castration Resistant Prostate Cancer.

Author information

1
Division of Hematology/Oncology, University of Michigan, Ann Arbor, Michigan.
2
Urology Cancer Center and GU Research Network, Omaha, Nebraska.
3
Roswell Park Cancer Institute, Buffalo, New York.
4
Fred Hutchinson Cancer Research Center, Seattle, Washington.
5
Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, Indiana.
6
Department of Translational Medicine, Urological Cancer, Lund University, Lund, Sweden.

Abstract

BACKGROUND:

We sought to identify potential clinical variables associated with outcomes after radium-223 therapy in routine practice.

METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

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.

KEYWORDS:

Bone Scan Index; outcomes; variables

PMID:
27990667
DOI:
10.1002/pros.23286
[Indexed for MEDLINE]

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