Dr. George on the Use of Radium-223 in Prostate Cancer

Daniel J. George, MD
Published: Tuesday, Sep 17, 2019



Daniel J. George, MD, professor of medicine and surgery, member, Duke Cancer Institute, discusses the use of radium-223 dichloride (Xofigo) in prostate cancer.

Radium-223 operates through a novel mechanism and has shown a reduction in the risk of progression or death of approximately 30% versus placebo in patients with metastatic castrate-resistant prostate cancer. Although the drug has shown a benefit in overall survival in a historically difficult-to-treat patient population, it has not been shown to affect prostate-specific antigen response or imaging response. As such, it has been difficult to employ in practice, says George.

Moreover, data from the phase III ERA-223 trial, which were presented at the 2018 ESMO Congress, pointed to the added complication of risk of fractures. In the trial, chemotherapy-naïve patients with mCRPC received abiraterone acetate (Zytiga), prednisone, and radium-223, or abiraterone and prednisone alone. Patients who received radium-223 had a higher rate of fractures than those who received abiraterone and prednisone alone. This was a new finding, says George, suggesting a potentially toxic synergy between abiraterone, prednisone, and radium-223 in a less heavily pretreated patient population. Now, there is a warning against the use of radium-223 in combination with abiraterone. However, because bone metastases lead to increased risk of mortality, George states that radium-223 can be used as monotherapy to lessen the burden of metastatic disease.
SELECTED
LANGUAGE


Daniel J. George, MD, professor of medicine and surgery, member, Duke Cancer Institute, discusses the use of radium-223 dichloride (Xofigo) in prostate cancer.

Radium-223 operates through a novel mechanism and has shown a reduction in the risk of progression or death of approximately 30% versus placebo in patients with metastatic castrate-resistant prostate cancer. Although the drug has shown a benefit in overall survival in a historically difficult-to-treat patient population, it has not been shown to affect prostate-specific antigen response or imaging response. As such, it has been difficult to employ in practice, says George.

Moreover, data from the phase III ERA-223 trial, which were presented at the 2018 ESMO Congress, pointed to the added complication of risk of fractures. In the trial, chemotherapy-naïve patients with mCRPC received abiraterone acetate (Zytiga), prednisone, and radium-223, or abiraterone and prednisone alone. Patients who received radium-223 had a higher rate of fractures than those who received abiraterone and prednisone alone. This was a new finding, says George, suggesting a potentially toxic synergy between abiraterone, prednisone, and radium-223 in a less heavily pretreated patient population. Now, there is a warning against the use of radium-223 in combination with abiraterone. However, because bone metastases lead to increased risk of mortality, George states that radium-223 can be used as monotherapy to lessen the burden of metastatic disease.

View Conference Coverage
Online CME Activities
TitleExpiration DateCME Credits
Publication Bottom Border
Border Publication
x