Imaging response during therapy with radium-223 for castration-resistant prostate cancer with bone metastases—analysis of an international multicenter database

Keizman, Daniel; Fosboel, M O; Reichegger, Hermann; Peer, Avivit; Rosenbaum, Eli; Desax, M-C; Neiman, Victoria; Petersen, Peter Meidahl; Mueller, Joachim; Cathomas, Richard; Gottfried, Maya; Dresler, Hadas; Sarid, David; Mermershtain, Wilmosh; Rouvinov, Keren; Mortensen, Jann; Gillessen, Silke; Daugaard, Gedske; Omlin, Aurelius

doi:10.1038/pcan.2017.6

Cited by 42 publications

(46 citation statements)

References 16 publications

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“…Prior retrospective series have demonstrated varying rates of bone and soft tissue progression with radium‐223. For example, a multicenter retrospective review of 130 men treated with radium‐223 reported CT progression in 46% (n = 57 of 124) and bone scan progression in only 6% (n = 6 of 99) of men with available imaging . Another retrospective series of 29 men treated with radium‐223 described improvement in bone scans in 14%, worsening of bone scans in 21%, and stable bone scans in 38% of men after radium‐223.…”

Section: Discussionmentioning

confidence: 99%

“…Radium‐223 was FDA approved on the basis of the Phase 3 ALSYMPCA trial, which demonstrated that radium‐223 improved overall survival and delayed the time to first symptomatic skeletal event, compared with placebo, among patients with symptomatic nonvisceral bone predominant metastatic castrate‐resistant prostate cancer (mCRPC) who had received, were not eligible to receive, or declined docetaxel. Notably, imaging was not obtained in ALSYMPCA, and retrospective series suggest variable rates of both soft tissue and bone progression over time with radium‐223 . As a result, the radiographic response to radium‐223 is poorly understood.…”

Section: Introductionmentioning

confidence: 99%

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Patterns of response and progression in bone and soft tissue during and after treatment with radium‐223 for metastatic castrate‐resistant prostate cancer

McNamara¹,

Oyekunle²,

Chin

et al. 2019

The Prostate

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Background Radium‐223 improves survival and time to first symptomatic skeletal event in symptomatic bone predominant metastatic castrate‐resistant prostate cancer (mCRPC). The imaging response to radium‐223 has not been well characterized. Methods To describe patterns of response and progression with radium‐223, we performed a retrospective review of all mCPRC patients who received radium‐223 at Duke from 1 June 2013 to 1 June 2015. Radionuclide bone scans obtained at baseline, during, and after treatment were reviewed by two radiologists. The automated bone scan index (aBSI) was generated at each time point using EXINI boneBSI version 2.4. Computed tomography (CT) and magnetic resonance imaging (MRI) clinical radiology reports were reviewed to evaluate for soft tissue, visceral, epidural, and bone progression. Clinical data were abstracted from the electronic health record. Results We identified 61 men who received at least one dose of radium‐223 at Duke during the study period (median, 5 doses; range, 1‐6). Among men with imaging during treatment, 2 of 14 (14.3%) had resolution of greater than or equal to 1 lesion on bone scan, 4 of 14 (28.6%) had zero new bone lesions, 10 of 14 (71.4%) had greater than or equal to 1 new bone lesion, 14 of 26 (53.9%) progressed on CT. After radium‐223, 6 of 39 (15.4%) had resolution of 1 to 4 bone lesions, 15 of 39 (38.5%) demonstrated zero new bone lesions, 24 of 39 (61.5%) progressed on bone scan, 15 of 37 (40.5%) progressed on CT, and 10 of 34 (29.4%) progressed on both bone scan and CT. No men with zero new bone lesions after radium‐223 ultimately progressed in bone alone and only 3 of 15 eventually demonstrated any progression in the bone. aBSI decreased significantly from baseline to after radium‐223 among men with zero new bone lesions (median change in aBSI −0.23 [IQR, −1.5, 0.02]) and increased significantly for men with greater than or equal to 1 new postradium bone lesions (median change in aBSI 1.41 [IQR, −0.05, 3.63] [P = 0.018]). Conclusions Bone and soft tissue progression during and following radium‐223 is common in heavily pretreated men with mCRPC. However, stable disease and responses were observed in a subset of patients and may be associated with durable treatment response in the bone. Prospective studies are needed to further investigate the change in aBSI as a biomarker of bone scan response/stabilization and progression following treatment with radium‐223.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Patterns of response and progression in bone and soft tissue during and after treatment with radium‐223 for metastatic castrate‐resistant prostate cancer

McNamara¹,

Oyekunle²,

Chin

et al. 2019

The Prostate

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“…A recent multicenter study retrospectively evaluated CT and bone scintigraphy response in 130 patients treated with radium-223. 61 The authors concluded that bone progression was rare (6%), although a flare (pain and/or radiologic) phenomenon may be noted at 3 months and should not be confused with progression. CT imaging after 3 and 6 doses of radium-223 was suggested to rule out visceral disease progression that may necessitate discontinuing radium-223 in favor of chemotherapy or a new hormonal agent.…”

Section: Daniel Heinrich Et Almentioning

confidence: 99%

“…Disease monitoring in bone is problematic, with flare phenomena on computed tomography (CT) and bone scans reported. 44,61 Whole body magnetic resonance imaging (MRI) and positron emission tomography imaging are considered to be the best options for assessing the extent of disease, whereas MRI appears to be most promising for measuring response, 62 although this has not been validated for radium-223. However, MRI is not in regular clinical use owing to restricted resources.…”

Section: Daniel Heinrich Et Almentioning

confidence: 99%

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The Contemporary Use of Radium-223 in Metastatic Castration-resistant Prostate Cancer

Heinrich

Bektic

Bergman

et al. 2018

Clinical Genitourinary Cancer

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Radium-223 dichloride (radium-223) was approved for the treatment of patients with castration-resistant prostate cancer (CRPC) and symptomatic bone metastases in the United States and Europe in 2013. This followed a reported overall survival benefit for patients treated with radium-223 and best standard of care (BSoC) when compared with placebo and BSoC in the ALpharadin in SYMptomatic Prostate CAncer (ALSYMPCA) trial. At that time, docetaxel was the standard first-line choice for patients with metastatic CRPC (mCRPC). Since then, the treatment landscape has changed dramatically with new hormonal agents (abiraterone and enzalutamide) considered to be the first-line choice for many patients. The optimal patient profile for radium-223 in the modern setting, and its best use either in sequence or in combination with other approved agents are unclear, with few definitive guidelines available. This article reports on the views of a group of urologists and medical oncologists experienced in treating patients with mCRPC with radium-223 in routine clinical practice. The aim is to provide an overview of the current use of radium-223 in the treatment of patients with mCRPC, and to discuss best practices for patient selection and on-treatment monitoring. Where agreement was reached, guidance on the optimal use of radium-223 is provided.

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Targeted Radionuclide Therapy for Bone Metastasis

Pandit‐Taskar

Mahajan

2022

Nuclear Oncology

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Imaging response during therapy with radium-223 for castration-resistant prostate cancer with bone metastases—analysis of an international multicenter database

Cited by 42 publications

References 16 publications

Patterns of response and progression in bone and soft tissue during and after treatment with radium‐223 for metastatic castrate‐resistant prostate cancer

Patterns of response and progression in bone and soft tissue during and after treatment with radium‐223 for metastatic castrate‐resistant prostate cancer

The Contemporary Use of Radium-223 in Metastatic Castration-resistant Prostate Cancer

Targeted Radionuclide Therapy for Bone Metastasis

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