Bone metastases reduce the quality of life and warrant an adequate management to avoid functional impairments. Almost half of CRPC patients develop significant bone pain, skeletal-related complications, or both, with complications including pathologic fractures, spinal compression, malignant hypercalcemia, and bone marrow suppression. The prognosis of CRPC is poor with shorter survival compared with those with castrate-sensitive disease. However, progression in spite of castrate levels of testosterone inevitably develops, which has been termed castration-resistant prostate cancer (CRPC). Patients with metastatic prostate cancer are initially treated with medical or surgical androgen deprivation. More than 90% of patients with advanced prostate cancer have bone metastases. Up to 85% of prostate cancer patients present with localized disease, but nearly 40% ultimately develop metastatic disease. Based on data from 2009–2013, the number of new cases of prostate cancer was 129.4 per 100,000 men per year, and the number of deaths was 20.7 per 100,000 men per year. In 2013, there were an estimated 2,850,139 men living with prostate cancer in the United States. Approximately 14.0% of men will be diagnosed with prostate cancer at some point during their lifetime according to the 2010–2012 data. Prostate cancer is the most common cancer in men in the United States and the third leading cause of cancer death among men after lung cancer and colon cancer. In this article, the physics and radiobiology, as well as a literature update on the use of Radium-223, are provided along with case presentations, aiming at a better appreciation of research data as well as the assimilation of research data into clinical practice. Trials are also ongoing in patients with other primary cancers such as breast cancer, thyroid cancer, and renal cancer metastatic to bone. Clinical trials are currently investigating Radium-223 in additional clinical settings such as earlier asymptomatic disease and in combination with other agents including hormonal therapeutic agents and immunotherapeutic as well as chemotherapeutic agents. Currently, Radium-223 is approved as a single agent therapy for metastatic CRPC. Recent post hoc analyses of the phase III ALSYMPCA trial support the previously established safety profile as well as therapeutic effect and clinical outcome of Radium-223. Radium-223 dichloride (Xofigo®, Bayer HealthCare Pharmaceuticals Inc.) is the first α-particle emitter therapeutic agent approved by the FDA, with benefits in overall survival and delay in symptomatic skeletal event for patients with metastatic castrate-resistant prostate cancer (CRPC).
0 Comments
Leave a Reply. |