Dr. George on Radium-223 in Advanced Prostate Cancer

Daniel J. George, MD, the director of GU Oncology at the Duke Cancer Institute, elaborates on the incorporation of radium-223 (Xofigo) into the treatment of patients with metastatic castration-resistant prostate cancer (mCRPC).

In May 2013, radium-223 (formally known as Alpharadin) was approved by the FDA for the treatment of symptomatic mCRPC that spread to the bones. Most patients with metastatic disease, George notes, develop modest degrees of bone pain and the vast majorities have symptoms associated with bone metastases. As a result, treatment with radium-223 is appropriate across a broad population.

Overall, George recommends the utilization of radium-223 before chemotherapy for patients with bone predominant patterns and minor symptoms. Inversely, he notes, patients with more extensive soft tissue disease should receive chemotherapy first. Moreover, he notes, the overarching treatment decision can be personalized based on several characteristics. As an example, a patient with heavier clinical deconditioning should receive radium-223 before chemotherapy; however, in more robust patients, chemotherapy may be administered first.