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ONCAlert | Upfront Therapy for mRCC

Benefits and Limitations of Radium-223 in mCRPC

Scott T. Tagawa, MD
Published Online: 5:44 PM, Mon February 18, 2019

Scott T. Tagawa, MD, Richard A. Stratton Associate Professor in Hematology and Oncology, associate professor of clinical medicine & urology at Weill Cornell Medicine, associate attending physician, NewYork-Presbyterian–Weill Cornell Medical Center, discusses benefits and limitations of radium-223 dichloride (Xofigo) in patients with metastatic castration-resistant prostate cancer (mCRPC).

Radium-223 is an effective drug that has some remaining challenges, Tagawa says. It is a great drug because it targets the bone, which is the site of significant problems for the majority of men with mCRPC. Bone metastases can lead to symptoms or, ultimately, death. The downside is that radium-223 only targets the bone, so the natural tendency is to want to combine the drug with other types of therapy. Retrospective studies have suggested that radium-223 in combination with androgen receptor targeted agents is beneficial, but ARROW-223 demonstrated a high rate of fractures with abiraterone acetate (Zytiga) and radium-223 upfront at the same time.

The drug can also be combined with chemotherapy, Tagawa adds. A phase I/II study looking at radium-223 plus docetaxel versus docetaxel alone had a progression-free survival advantage, while appearing to be the safer option. The phase III DORA trial is looking to confirm this in a larger patient population.

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