A novel prediction model for the completion of six cycles of radium-223 treatment and survival in patients with metastatic castration-resistant prostate cancer

Abstract

Purpose We evaluated the predictive factors for completion of all six cycles of radium-223 (Ra-223) treatment in patients with metastatic castration-resistant prostate cancer (mCRPC). We also developed a novel prediction model for Ra-223 treatment completion using these predictors. Methods We retrospectively reviewed data from 122 patients with mCRPC who were treated with Ra-223. The predictive factors for the completion of six cycles of Ra-223 treatment were evaluated. Statistically significant predictive factors were then used to develop a prediction model for treatment completion. Finally, using this prediction model, we classified the overall survival (OS) of the entire cohort into three groups. Results We identified three significant variables as the predictive factors for treatment completion: baseline alkaline phosphatase (ALP) level, baseline hemoglobin (Hb) level, and baseline pain. The three groups generated using the prediction model were: group 1 (patients with three predictive factors, i.e., ALP < median, Hb ≥ median, and no pain), group 2 (patients with one to two predictive factors), and group 3 (patients without any predictive factors). The treatment completion rates differed between the three groups significantly. Furthermore, the OS also differed among the groups significantly. Conclusion Our study suggested that the baseline ALP level, baseline Hb level, and baseline pain were the predictive factors of completion of all six cycles of Ra-223 treatment in patients with mCRPC. Our prediction model consisting of these factors could predict not only the completion of Ra-223 treatment, but also the post-treatment survival. This model can thus be useful for selection of patients for Ra-223 treatment.

Administration of radium‐223 and the prognosis in Japanese bone metastatic castration‐resistant prostate cancer patients: A large database study

“…In contrast, in Japan, all CRPC patients with bone metastases can be treated with Ra‐223. To complete six courses of Ra‐223 and thereby obtain an OS benefit, not a few bone metastatic CRPC patients in Japan receive Ra‐223 without waiting for two or more new AR inhibitors or DOC 7,10 . While there have been many reports on patients treated with Ra‐223 in Japan, none have described the improvement in the OS with Ra‐223 compared with a cohort not treated with Ra‐223 (Table 2).…”

“…While there have been many reports on patients treated with Ra‐223 in Japan, none have described the improvement in the OS with Ra‐223 compared with a cohort not treated with Ra‐223 (Table 2). 5–12 Therefore, in the present study, we investigated whether or not Ra‐223 improves the OS in Japanese patients using a large‐scale healthcare fee database.…”

“…Ra‐223 is widely used in daily clinical practice in Japan for bone metastatic CRPC, with a total of 5852 vials administered annually in 2018 4 . There were several studies to confirm that completion of six‐course Ra‐223 showed longer survival compared to the one‐ to five‐course group and examined the factors who showed longer prognosis who received Ra‐223 in Japanese patients 5–14 . However, almost all studies of Ra‐223 from Japan have used patient cohorts receiving Ra‐223, with no non‐Ra‐223 induction patient cohorts included 2,5,7,10,11 …”

Novel nomogram developed for determining suitability of metastatic castration-resistant prostate cancer patients to receive maximum benefit from radium-223 dichloride treatment—Japanese Ra-223 Therapy in Prostate Cancer using Bone Scan Index (J-RAP-BSI) Trial

“…Despite increasing clinical experience with Ra-223 given to mCRPC patients, clinical variables useful for predicting response to that radiopharmaceutical and also survival remain di cult to identify. Scoring systems reported include baseline Eastern Cooperative Oncology Group (ECOG) performance status, levels of hemoglobin, alkaline phosphatase (ALP), lactate dehydrogenase (LDH), and prostate speci c antigen (PSA), PSA doubling time (PSADT), completion of six cycles of Ra-223, as well as other factors [5][6][7][8][9][10][11][12][13][14][15]. However, a validated and simple model for clinicians to assess which patients will most likely bene t from Ra-223 treatment remains to be elucidated.…”

The Role of Radiological Imaging in the Diagnosis and Treatment of Urolithiasis: A Narrative Review

“…Many analyzed reports from several randomized controlled trials have shown that ureteroscopy achieved high success rates in managing ureteric stones and provided a better stone-free rate after treatment, fewer re-interventions, fewer sick leave days, and lower healthcare costs. However, compared to ESWL and PCNL patients, those who had undergone ureteroscopy, unfortunately, continue to have remnant stone fragments that may cause recurrent symptoms, obstruction, infection, and a longer hospital stay [ 30 , 31 ].…”