Nicholas J. Vogelzang, MD, from the Comprehensive Cancer Centers of Nevada, discusses an updated analysis of the phase III ALSYMPCA trial that examined radium-223 dichloride in patients who have CRPC with bone metastases.
Nicholas J. Vogelzang, MD, member of the US Oncology Network, site research leader for Comprehensive Cancer Centers of Nevada, professor of medicine at the University of Nevada School of Medicine, discusses an updated analysis of the phase III ALSYMPCA trial that examined radium-223 dichloride in patients who have castration-resistant prostate cancer (CRPC) with bone metastases.
In the phase III ALSYMPCA trial, 921 patients were randomized 2:1 to receive radium-223, a novel alpha-emitting agent that targets bone metastases, or placebo with best supportive care. Vogelzang notes that a survival advantage in favor of radium-223 was comparable to other recently approved agents for prostate cancer, such as enzalutamide, abiraterone acetate, and sipuleucel-T.
In the trial, overall survival was 14.9 months compared to 11.3 in the placebo group (HR = 0.69; 95% CI: 0.58-0.83; P < .001). Vogelzang points out that treatment with radium-223 resulted in a marked reduction in pain and other side effects. Moreover, he adds, there were fewer side effects in the investigational arm than those receiving placebo.
In an updated analysis of skeletal-related events (SREs), treatment with radium-223 delayed time to first SRE by 5.8 months and reduced the risk of developing an SRE. Additionally, only very modest single digit bone marrow suppression was observed, Vogelzang adds.
In an example, Vogelzang notes that if he only had access to a few agents to treat prostate cancer he would select enzalutamide, radium-223, and abiraterone. Overall, these agents are all very powerful, he explains.