Radium-223 for primary bone metastases in patients with hormone-sensitive prostate cancer after radical prostatectomy
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Vera Wenter1,*, Annika Herlemann2,*, Wolfgang P. Fendler1, Harun Ilhan1, Natalia Tirichter1, Peter Bartenstein1,3, Christian G. Stief2,3, Christian la Fougère4,5, Nathalie L. Albert1, Axel Rominger1 and Christian Gratzke2,3
1Department of Nuclear Medicine, Ludwig-Maximilians-University of Munich, Munich, Germany
2Department of Urology, Ludwig-Maximilians-University of Munich, Munich, Germany
3Comprehensive Cancer Center, Ludwig-Maximilians-University of Munich, Munich, Germany
4Department of Nuclear Medicine and Clinical Molecular Imaging, Eberhard Karls University, Tuebingen, Germany
5German Cancer Consortium, German Cancer Research Center Partner Site Tuebingen, Tuebingen, Germany
*These authors have contributed equally to this work
Christian Gratzke, email: [email protected]
Keywords: hormone-sensitive prostate cancer, radium-223, radical prostatectomy, bone metastases, off-label use
Received: January 23, 2017 Accepted: April 03, 2017 Published: April 21, 2017
Radium-223 dichloride (Ra-223) is the first bone-targeting agent showing improvement in overall survival in patients with castration-resistant prostate cancer (CRPC) and bone metastases. We aimed to assess feasibility of Ra-223 treatment in patients with metastatic hormone-sensitive prostate cancer (mHSPC). Ten patients with primary bone metastases received Ra-223 following radical prostatectomy (RP). Changes in alkaline phosphatase (ALP) and prostate-specific antigen (PSA) were recorded, while pain intensity was evaluated using the self-reporting Brief Pain Inventory (BPI) questionnaire. Bone scintigraphy (BS) was performed to assess treatment response. Seven patients completed six cycles of Ra-223. Discontinuation was due to leuko- and lymphopenia, progressive lymph node metastasis or newly diagnosed liver metastasis. Treatment-related adverse events occurred in three patients and included leuko- and lymphopenia, fatigue, abdominal discomfort and nausea. Overall, a median decrease of 28% in ALP and a median decrease of 83% in PSA were noted at follow-up. However, PSA progressed in five patients at follow-up. Improvement of pain was observed in all patients (median decrease of 36% after 3 cycles and of 40% at the end of therapy). On BS, three patients showed remission, four had stable disease, and one showed progressive disease at follow-up. Our results suggest that Ra-223 for primary bone metastases in patients with mHSPC after RP is feasible and alleviates pain. ALP, rather than PSA, may be a good marker for assessing treatment response. Ra-223 could therefore be taken into consideration as part of a multimodal approach for carefully selected patients with advanced prostate cancer.
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