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REVIEW  BONE METASTASES IN THE ERA OF TARGETED TREATMENTS 

The Quarterly Journal of Nuclear Medicine and Molecular Imaging 2019 June;63(2):170-82

DOI: 10.23736/S1824-4785.19.03205-9

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

The changing role of radium-223 in metastatic castrate-resistant prostate cancer: has the EMA missed the mark with revising the label?

Tim Van den WYNGAERT 1, 2 , Bertrand TOMBAL 3, 4

1 Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium; 2 Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium; 3 Department of Urology, Saint Luc University Clinic, Brussels, Belgium; 4 Institute of Clinical Research, Catholic University of Louvain, Brussels, Belgium



Radium-223 (223Ra) is a life-prolonging treatment in symptomatic men with metastatic castrate-resistant prostate cancer (mCRPC) and bone metastases, but no visceral disease, regardless of prior treatment with docetaxel. Together with four other drugs (i.e. abiraterone, cabazitaxel, docetaxel, enzalutamide), it has been available for clinical use since 2013 and has been shown to also provide benefits in quality-of-life and societal benefits. However, in 2018 the European Medicines Agency ruled to restrict the use of radium-223 to a more advanced disease setting after at least two lines of one or the other life-prolonging agent. This decision was triggered by the results of a safety interim analysis of ERA-223, a trial investigating the combination of 223Ra and abiraterone versus abiraterone alone in patients without prior chemotherapy (with the exception of adjuvant treatment) with asymptomatic bone predominant mCRPC. That safety analysis showed an early increased risk of fracture and deaths with the combination treatment. This review critically appraises the available and emerging data with 223Ra treatment in an attempt to assess the appropriateness of the revised label of radium-223.


KEY WORDS: Radium-223; mCRPC; Neoplasm metastasis; Prostatic neoplasms; Radium Ra 223 dichloride

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