Radium-223 dichloride in clinical practice: a review

Florimonte, Luigia; Dellavedova, Luca; Maffioli, Lorenzo

doi:10.1007/s00259-016-3386-5

Cited by 33 publications

(32 citation statements)

References 90 publications

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“…Skeletal imaging with 18 F-fluoride PET/CT is superior to bone scintigraphy in metastatic PC patients because of greater sensitivity, specificity, and accuracy (26,34). Bone scintigraphy or 18 F-fluoride PET/CT should precede therapy with 223 Ra to determine active osteoblastic lesions, because the regional uptake of 223 Ra correlates with the intensity of bone metabolism (35).…”

Section: Discussionmentioning

confidence: 99%

⁶⁸Ga-PSMA-11 PET as a Gatekeeper for the Treatment of Metastatic Prostate Cancer with ²²³Ra: Proof of Concept

et al. 2016

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We retrospectively evaluated the utility of 68 Ga-PSMA-11 PET for planning 223 RaCl 2 therapy of patients with metastatic prostate cancer and its impact on the therapeutic response as determined by prostatespecific antigen (PSA) and alkaline phosphatase (ALP), as well as the correlation of PSA changes with the results of prostate-specific membrane antigen (PSMA) PET follow-up scans. Methods: Sixtythree patients with a median age of 73 y who underwent 307 cycles of therapy with 223 RaCl 2 were analyzed. In 31 patients, bone scanning and radiologic imaging were performed for pretherapeutic imaging (group 1). In 32 patients, bone scanning and PSMA PET were performed before therapy (group 2). Patients with small lymph node metastases and local recurrence were not excluded from treatment, consistent with current guidelines. PSA and ALP were measured before each treatment cycle and 4 wk after the final cycle. Thirteen patients from group 2, who underwent a second PSMA PET scan as a followup, were evaluated to determine the significance of PSA changes as a follow-up marker. Results: In group 1, 4 patients (12.9%) showed a PSA decline, of whom 2 patients and 1 patient showed a PSA decline of more than 30% and more than 50%, respectively. In contrast, in group 2, 14 patients (43.8%) showed a PSA decline, of whom 10 and 8 patients showed a decline of more than 30% and more than 50%, respectively (P 5 0.007). Thirty-seven patients had a high ALP level (19 from group 1 and 18 from group 2). Twelve (63.2%) and 16 (88.9%) patients in groups 1 and 2, respectively, showed an ALP decline. This difference was not significant; however, 7 (36%) and 13 (72.2%) patients in groups 1 and 2, respectively, showed an ALP decline of more than 30% (P 5 0.04). Considering any ALP decline as a response, no patient with increasing ALP showed a PSA response (P 5 0.036). There was a significant correlation between the PSA changes and the therapeutic response according to follow-up PSMA PET. Conclusion: When PSMA PET is used as the gatekeeper in addition to bone scanning, radionuclide therapy with 223 Ra may be more effective and have more success regarding changes in the PSA. An increase in PSA during therapy cycles occurs because of disease progression.

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Section: Discussionmentioning

confidence: 99%

⁶⁸Ga-PSMA-11 PET as a Gatekeeper for the Treatment of Metastatic Prostate Cancer with ²²³Ra: Proof of Concept

et al. 2016

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“…Bisphosphonates, zoledronic acid (53) and mostly antibodies to RANKL (denosumab) are able to delay SREs (20), the combined use of these agents with 223 Ra can achieve a synergistic effect (6,35). In addition prostatespecific membrane antigen (PSMA) seems to be a promising diagnostic and therapeutic target (54) for CRPCa even if it has not been tested in humans yet.…”

Section: % P<0001)mentioning

confidence: 99%

“…Almost 90% of men who die from PCa have bone-metastatic disease (6), with a 5-year OS rate of 20%. Due to the fragility of bone with metastases, with the related risk of pain, fractures, spinal cord compression and hematological consequences, several drugs have been developed to treat the osseous involvement of this disease.…”

Section: Abstract 223 Ra Prolongs Overall Survival In Symptomatic Pamentioning

confidence: 99%

“…On the basis of the results of the ALSYMPCA trial, national medicinal agencies imposed eligibility criteria for 223 Ra treatment accessibility (6). These eligibility criteria are the definitive diagnosis of symptomatic CRPCa, with only prostate bed and bone localization, serum testosterone level lower than 50 ng/dl, M1 stage, no previous treatment with 223 Ra or concomitant treatment with abiraterone, enzalutamide or other chemotherapic agents, with an ECOG performance status lower than 4.…”

Section: % P<0001)mentioning

confidence: 99%

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Radium-223: Insight and Perspectives in Bone-metastatic Castration-resistant Prostate Cancer

Buroni

Persico

Pasi

et al. 2016

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Abstract. 223 Prostate cancer (PCa) is the most common malignancy in men (1). In patients affected by advanced PCa, defined as hormonesensitive disease since the tumor still requires androgen for growth, androgen deprivation therapy (ADT), including luteinizing hormone-releasing hormone (LHRH) agonists, antagonists and anti-androgens, represents the first-line treatment. Unfortunately some cancer cells develop resistance to ADT, indicating the progression of the disease to metastatic castration-resistant prostate cancer (mCRPCa). Such resistance to castration occurs in most patients (2) and, despite the approval of new therapeutic agents, mCRPCa remains a lethal disease (3). Nowadays the new therapeutic landscape for patients affected by mCRPCa aims to extend overall survival (OS) and includes cytotoxic, new-generation anti-androgens, immunotherapeutics and radiopharmaceuticals (4, 5).Bones are the preferred site of metastasis. Almost 90% of men who die from PCa have bone-metastatic disease (6), with a 5-year OS rate of 20%. Due to the fragility of bone with metastases, with the related risk of pain, fractures, spinal cord compression and hematological consequences, several drugs have been developed to treat the osseous involvement of this disease. In previous years, the optimal treatment aimed to relieve pain and reduce skeletal morbidity.Besides systemic therapies, bone-targeted agents that focus their activity on bone, such as bisphosphonates, monoclonal antibody and radiopharmaceuticals, have become available. The bisphosphonate zoledronic acid, the antibody to receptor activator of nuclear factor kappa-B ligand (RANKL) denosumab and radiopharmaceuticals [such as 89 Sr and 153 Sm-ethylene diamine tetramethylene phosphonate ( 153 Sm-EDTMP)], were approved for delaying skeletal-related events (SREs) and for the palliation of bone pain from mCRPCa. Radionuclide TherapyRadionuclide therapy is known to deliver ionizing radiation to tumor sites, thereby killing cancer cells (7). Bone-targeted radiopharmaceuticals localize their radiation to sites of high bone remodeling. 5719

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“…Ceci et al [17] discuss the use of PET for therapy monitoring in castration resistant prostate cancer. Of note, the success of nuclear medicine in prostate cancer is based not only on its diagnostic capabilities, but also on achieving a gain in overall survival as well as improvement of quality of life in bonemetastatic refractory prostate cancer patients treated with Radium 223 [18,19]. Etchebehere et al [20] review the use of Sodium Fluoride PET in this setting, using this probe for baseline tumor burden assessment and to monitor the effect of radium 223 .…”

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confidence: 99%

Therapy monitoring with PET in cancer patients: achievements, opportunities and challenges ahead for the PET community

Aide

Fanti

2017

Eur J Nucl Med Mol Imaging

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It has been 18 years since the first guidelines on PET response criteria were released [1] (with little supporting data at that time) and 15 years since the first successful use of PET for evaluation of a molecularly targeted therapy (imatinib) was published [2]. This latter study demonstrated the huge potential of PET imaging in assessing tumor response early after treatment initiation, at a time when conventional criteria based on size measurements (RECIST) were found to be unsatisfactorily. Since then, numerous studies using FDG PET as a surrogate marker to evaluate response to therapy have been published; PET Response Criteria In Solid Tumors (PERCIST) have been introduced [3,4] and data regarding repeatability of PET have been published, supporting the use of thresholds to discriminate between responders and non-responders [5,6]. Nonetheless, unfortunately, FDG PET is far from being a standard tool in clinical trials assessing new antineoplastic tools, but there have been indeed relevant progress.It is our pleasure to introduce this special issue of the EJNMMI dedicated to therapy monitoring with PET in cancer patients, in which the reader will find up-to-date information on the basis of tumor biology and new PET technologies for therapy assessment with FDG and other PET probes in solid tumors and in hematological tumors.We have divided the issue into four sections. The first section includes a recent update on PET technologies and two articles discussing the motivations and methodology for harmonization of PET data and the challenges faced when implementing PET in clinical trials. It is followed by a section including a practical guide to better understand molecularly targeted therapies, and a comprehensive review on the use of the EORTC PET response criteria as well as the PERCIST. The third section reviews therapy monitoring with 18 F-FDG, 18 F-or 11 C-Choline, 68 Ga-PSMA and Sodium Fluoride in solid tumors, while the fourth and last section reviews therapy monitoring in hematological malignancies.One might consider that the natural history of PET technologies and antineoplastic drugs is somewhat similar, both being characterized by continuous improvements and from time to time a major breakthrough. In this EJNMMI special issue, Van der Vos et al. [7] review hardware (digital PET) and software (advanced reconstruction algorithms) PET technological improvements, digital PET being expected as a major breakthrough by the PET community. While these advances give our community great opportunities such as a better staging capability thanks to an improvement in small lesions detectability, they also bring challenges in getting harmonized images/quantitative values in PET centers running different PET systems and in multicentre clinical trials, as reviewed by Aide et al. [8] in a paper also discussing the EANM response to this issue, namely the EARL accreditation program. Yet, harmonization of PET data is only one of the problems faced by the medical oncology and PET communities when trying to implement PET wi...

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Radium-223 dichloride in clinical practice: a review

Cited by 33 publications

References 90 publications

⁶⁸Ga-PSMA-11 PET as a Gatekeeper for the Treatment of Metastatic Prostate Cancer with ²²³Ra: Proof of Concept

⁶⁸Ga-PSMA-11 PET as a Gatekeeper for the Treatment of Metastatic Prostate Cancer with ²²³Ra: Proof of Concept

Radium-223: Insight and Perspectives in Bone-metastatic Castration-resistant Prostate Cancer

Therapy monitoring with PET in cancer patients: achievements, opportunities and challenges ahead for the PET community

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Radium-223 dichloride in clinical practice: a review

Cited by 33 publications

References 90 publications

68Ga-PSMA-11 PET as a Gatekeeper for the Treatment of Metastatic Prostate Cancer with 223Ra: Proof of Concept

68Ga-PSMA-11 PET as a Gatekeeper for the Treatment of Metastatic Prostate Cancer with 223Ra: Proof of Concept

Radium-223: Insight and Perspectives in Bone-metastatic Castration-resistant Prostate Cancer

Therapy monitoring with PET in cancer patients: achievements, opportunities and challenges ahead for the PET community

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Product

Resources

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⁶⁸Ga-PSMA-11 PET as a Gatekeeper for the Treatment of Metastatic Prostate Cancer with ²²³Ra: Proof of Concept

⁶⁸Ga-PSMA-11 PET as a Gatekeeper for the Treatment of Metastatic Prostate Cancer with ²²³Ra: Proof of Concept