Robert Dreicer, MD
Radium-223 dichloride (Xofigo) has proved to be a game-changer in the radiopharmaceutical scene, specifically with the treatment of patients with metastatic castration-resistant prostate cancer (mCRPC), explains Robert Dreicer, MD.
, Dreicer, associate director for Clinical Research and deputy director of the University of Virginia Cancer Center, discusses the key questions that surround the optimal use and sequencing of radium-223 in patients with mCRPC and how the treatment has altered the field of radiopharmaceuticals.
OncLive: What is the optimal use of radium-223 in the setting of mCRPC?
: Radium-223 is an interesting compound because it is not an androgen receptor (AR)¬–directed therapy and, in prostate cancer, a lot of our therapies are AR-directed. For patients with predominant bone metastases, the drug has been approved prior or posttreatment with docetaxel. For selected patients, it becomes a very useful therapy. What is clear is that the duration of therapy—a 6-month period—a disease that may evolve from an AR perspective is not really being managed by radium-223.
How to integrate the AR-directed therapies with radium-223 are questions that are now being addressed prospectively. This is really one of those therapies that sort of came upon the scene and clearly has activity, but the optimal use is really not yet defined.
What are your thoughts on administering radium-223 in earlier settings of therapy?
When we talk about early, the question is, “Is this a therapy that should be used before AR therapeutics?” I don’t think we know the answer to that. It has clearly been approved for early use, but most patients still wind up getting AR-directed therapy as an initial treatment. Additionally, whether or not radium-223 needs to be integrated into that are questions that are going to be addressed clinically from a research perspective.
How do you envision radium-223 fitting in sequentially, and what research is seeking to answer this?
Radium-223 is not an AR-mediated therapy; the fact that it is a non-AR–targeted therapy has its own advantages. Obviously, there is survival data. This is a therapy that is really bone targeted, so one has to begin to think about how to integrate this optimally.
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