Radium‐223 dichloride treatment in metastatic castration‐resistant prostate cancer in Finland: A real‐world evidence multicenter study
Abstract Background Radium‐233 dichloride is an alpha emitter that specifically targets bone metastases in prostate cancer. Results of a previously reported phase III randomized trial showed survival benefit for radium‐223 compared to best supportive care in castration‐resistant prostate cancer (CRP...
| Main Authors: | , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2023-02-01
|
| Series: | Cancer Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/cam4.5262 |
| _version_ | 1797893236868513792 |
|---|---|
| author | Anniina Hyväkkä Okko‐Sakari Kääriäinen Tapio Utriainen Eliisa Löyttyniemi Kalle Mattila Petri Reinikainen Jorma Sormunen Minna Jääskeläinen Päivi Auvinen Heikki Minn Maria Sundvall |
| author_facet | Anniina Hyväkkä Okko‐Sakari Kääriäinen Tapio Utriainen Eliisa Löyttyniemi Kalle Mattila Petri Reinikainen Jorma Sormunen Minna Jääskeläinen Päivi Auvinen Heikki Minn Maria Sundvall |
| author_sort | Anniina Hyväkkä |
| collection | DOAJ |
| description | Abstract Background Radium‐233 dichloride is an alpha emitter that specifically targets bone metastases in prostate cancer. Results of a previously reported phase III randomized trial showed survival benefit for radium‐223 compared to best supportive care in castration‐resistant prostate cancer (CRPC) with bone metastases. However, real‐world data are also needed with wider inclusion criteria. Methods We report results of a retrospective multicenter study including all patients with metastatic CRPC treated with radium‐223 in all five university hospitals in Finland since the introduction of the treatment. We identified 160 patients who had received radium‐223 in Finland in 2014–2019. Results The median overall survival (OS) was 13.8 months (range 0.5–57 months), and the median real‐world progression‐free survival (rwPFS) was 4.9 months (range 0.5–29.8 months). Alkaline phosphatase (ALP) values within the normal range before and during the radium‐223 treatment or the reduction of elevated ALP to normal range during treatment were associated with better OS when compared to elevated ALP values before and during treatment (p < 0.0001). High prostate‐specific antigen (PSA) level (≥100 μg/L) before radium‐223 treatment was associated with poor OS compared to low PSA level (<20 μg/L) (p = 0.0001). Most patients (57%) experienced pain relief. Pain relief indicated better OS (p = 0.002). Radium‐223 treatment was well tolerated. Toxicity was mostly low grade. Only 12.5% of the patients had grade III–IV adverse events, most commonly anemia, neutropenia, leucopenia, and thrombocytopenia. Conclusion Radium‐223 was well tolerated in routine clinical practice, and most patients achieved pain relief. Pain relief, ALP normalization, lower baseline PSA, and PSA decrease during radium‐223 treatment were prognostic for better survival. The efficacy of radium‐223 in mCRPC as estimated using OS was comparable to earlier randomized trial in this retrospective real‐world study. Our results support using radium‐223 for mCRPC patients with symptomatic bone metastases even in the era of new‐generation androgen receptor‐targeted agents. |
| first_indexed | 2024-04-10T06:49:40Z |
| format | Article |
| id | doaj.art-988c21ee30f643d0a357eb178ee4fb33 |
| institution | Directory Open Access Journal |
| issn | 2045-7634 |
| language | English |
| last_indexed | 2024-04-10T06:49:40Z |
| publishDate | 2023-02-01 |
| publisher | Wiley |
| record_format | Article |
| series | Cancer Medicine |
| spelling | doaj.art-988c21ee30f643d0a357eb178ee4fb332023-02-28T08:51:57ZengWileyCancer Medicine2045-76342023-02-011244064407610.1002/cam4.5262Radium‐223 dichloride treatment in metastatic castration‐resistant prostate cancer in Finland: A real‐world evidence multicenter studyAnniina Hyväkkä0Okko‐Sakari Kääriäinen1Tapio Utriainen2Eliisa Löyttyniemi3Kalle Mattila4Petri Reinikainen5Jorma Sormunen6Minna Jääskeläinen7Päivi Auvinen8Heikki Minn9Maria Sundvall10Cancer Research Unit, Institute of Biomedicine, and Department of Oncology FICAN West Cancer Center, University of Turku, Turku University Hospital Turku FinlandDepartment of Oncology Kuopio University Hospital Kuopio FinlandHelsinki University Hospital Comprehensive Cancer Center Helsinki FinlandDepartment of Biostatistics, Institute of Clinical Medicine University of Turku Turku FinlandDepartment of Oncology and FICAN West Cancer Center University of Turku, Turku University Hospital Turku FinlandDepartment of Oncology Tampere University Hospital Tampere FinlandDepartment of Oncology Tampere University Hospital Tampere FinlandDepartment of Oncology Oulu University Hospital Oulu FinlandDepartment of Oncology Kuopio University Hospital Kuopio FinlandDepartment of Oncology and FICAN West Cancer Center University of Turku, Turku University Hospital Turku FinlandCancer Research Unit, Institute of Biomedicine, and Department of Oncology FICAN West Cancer Center, University of Turku, Turku University Hospital Turku FinlandAbstract Background Radium‐233 dichloride is an alpha emitter that specifically targets bone metastases in prostate cancer. Results of a previously reported phase III randomized trial showed survival benefit for radium‐223 compared to best supportive care in castration‐resistant prostate cancer (CRPC) with bone metastases. However, real‐world data are also needed with wider inclusion criteria. Methods We report results of a retrospective multicenter study including all patients with metastatic CRPC treated with radium‐223 in all five university hospitals in Finland since the introduction of the treatment. We identified 160 patients who had received radium‐223 in Finland in 2014–2019. Results The median overall survival (OS) was 13.8 months (range 0.5–57 months), and the median real‐world progression‐free survival (rwPFS) was 4.9 months (range 0.5–29.8 months). Alkaline phosphatase (ALP) values within the normal range before and during the radium‐223 treatment or the reduction of elevated ALP to normal range during treatment were associated with better OS when compared to elevated ALP values before and during treatment (p < 0.0001). High prostate‐specific antigen (PSA) level (≥100 μg/L) before radium‐223 treatment was associated with poor OS compared to low PSA level (<20 μg/L) (p = 0.0001). Most patients (57%) experienced pain relief. Pain relief indicated better OS (p = 0.002). Radium‐223 treatment was well tolerated. Toxicity was mostly low grade. Only 12.5% of the patients had grade III–IV adverse events, most commonly anemia, neutropenia, leucopenia, and thrombocytopenia. Conclusion Radium‐223 was well tolerated in routine clinical practice, and most patients achieved pain relief. Pain relief, ALP normalization, lower baseline PSA, and PSA decrease during radium‐223 treatment were prognostic for better survival. The efficacy of radium‐223 in mCRPC as estimated using OS was comparable to earlier randomized trial in this retrospective real‐world study. Our results support using radium‐223 for mCRPC patients with symptomatic bone metastases even in the era of new‐generation androgen receptor‐targeted agents.https://doi.org/10.1002/cam4.5262bone metastasescastration‐resistant prostate cancerradium‐233 (Ra‐223) therapyreal‐world evidence |
| spellingShingle | Anniina Hyväkkä Okko‐Sakari Kääriäinen Tapio Utriainen Eliisa Löyttyniemi Kalle Mattila Petri Reinikainen Jorma Sormunen Minna Jääskeläinen Päivi Auvinen Heikki Minn Maria Sundvall Radium‐223 dichloride treatment in metastatic castration‐resistant prostate cancer in Finland: A real‐world evidence multicenter study Cancer Medicine bone metastases castration‐resistant prostate cancer radium‐233 (Ra‐223) therapy real‐world evidence |
| title | Radium‐223 dichloride treatment in metastatic castration‐resistant prostate cancer in Finland: A real‐world evidence multicenter study |
| title_full | Radium‐223 dichloride treatment in metastatic castration‐resistant prostate cancer in Finland: A real‐world evidence multicenter study |
| title_fullStr | Radium‐223 dichloride treatment in metastatic castration‐resistant prostate cancer in Finland: A real‐world evidence multicenter study |
| title_full_unstemmed | Radium‐223 dichloride treatment in metastatic castration‐resistant prostate cancer in Finland: A real‐world evidence multicenter study |
| title_short | Radium‐223 dichloride treatment in metastatic castration‐resistant prostate cancer in Finland: A real‐world evidence multicenter study |
| title_sort | radium 223 dichloride treatment in metastatic castration resistant prostate cancer in finland a real world evidence multicenter study |
| topic | bone metastases castration‐resistant prostate cancer radium‐233 (Ra‐223) therapy real‐world evidence |
| url | https://doi.org/10.1002/cam4.5262 |
| work_keys_str_mv | AT anniinahyvakka radium223dichloridetreatmentinmetastaticcastrationresistantprostatecancerinfinlandarealworldevidencemulticenterstudy AT okkosakarikaariainen radium223dichloridetreatmentinmetastaticcastrationresistantprostatecancerinfinlandarealworldevidencemulticenterstudy AT tapioutriainen radium223dichloridetreatmentinmetastaticcastrationresistantprostatecancerinfinlandarealworldevidencemulticenterstudy AT eliisaloyttyniemi radium223dichloridetreatmentinmetastaticcastrationresistantprostatecancerinfinlandarealworldevidencemulticenterstudy AT kallemattila radium223dichloridetreatmentinmetastaticcastrationresistantprostatecancerinfinlandarealworldevidencemulticenterstudy AT petrireinikainen radium223dichloridetreatmentinmetastaticcastrationresistantprostatecancerinfinlandarealworldevidencemulticenterstudy AT jormasormunen radium223dichloridetreatmentinmetastaticcastrationresistantprostatecancerinfinlandarealworldevidencemulticenterstudy AT minnajaaskelainen radium223dichloridetreatmentinmetastaticcastrationresistantprostatecancerinfinlandarealworldevidencemulticenterstudy AT paiviauvinen radium223dichloridetreatmentinmetastaticcastrationresistantprostatecancerinfinlandarealworldevidencemulticenterstudy AT heikkiminn radium223dichloridetreatmentinmetastaticcastrationresistantprostatecancerinfinlandarealworldevidencemulticenterstudy AT mariasundvall radium223dichloridetreatmentinmetastaticcastrationresistantprostatecancerinfinlandarealworldevidencemulticenterstudy |