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Suominen MI, Knuuttila M, Sjöholm B, Wilson T, Alhoniemi E, Mumberg D, Käkönen SM, Scholz A. Zoledronic Acid Prevents Bone Resorption Caused by the Combination of Radium-223, Abiraterone Acetate, and Prednisone in an Intratibial Prostate Cancer Mouse Model. Cancers (Basel) 2023; 15:4115. [PMID: 37627143 PMCID: PMC10452892 DOI: 10.3390/cancers15164115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/04/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023] Open
Abstract
An increased risk of non-pathological fractures in patients with prostate cancer and bone metastases has been associated with combination treatment with radium-223, abiraterone, and prednisone/prednisolone in the absence of bone-protecting agents. Here, we investigated possible mechanisms leading to this outcome using an intratibial LNCaP model mimicking prostate cancer bone metastases. Male NOD.scid mice were inoculated intratibially with LNCaP prostate cancer cells and treated with vehicle, radium-223, abiraterone, prednisone, zoledronic acid, or their combinations for 28 days. Serum TRACP 5b and PSA levels were measured. Bone structure, quality, and formation rate of non-tumor-bearing and tumor-bearing tibiae were analyzed by microCT, 3-point bending assay, and dynamic histomorphometry, respectively. Radium-223 incorporation into bone was also measured. Radium-223/abiraterone/prednisone combination treatment induced a transient increase in bone resorption indicated by elevated TRACP 5b levels, which was inhibited by concurrent treatment with zoledronic acid. Furthermore, radium-223/abiraterone/prednisone combination reduced periosteal and trabecular new bone formation and the number of osteoblasts, but bone structure or biomechanical quality were not affected. The abiraterone/prednisone treatment decreased radium-223 incorporation into tumor-bearing bone, possibly explaining the lack of additional antitumor efficacy. In conclusion, radium-223/abiraterone/prednisone combination increased bone resorption, which may have been one of the mechanisms leading to an increased fracture risk in patients with mCRPC.
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Affiliation(s)
| | | | | | | | | | - Dominik Mumberg
- Research & Development, Pharmaceuticals, Bayer AG, 13353 Berlin, Germany
| | - Sanna-Maria Käkönen
- Aurexel Life Sciences Ltd., 21240 Askainen, Finland
- Institute of Biomedicine, University of Turku, 20520 Turku, Finland
| | - Arne Scholz
- Research & Development, Pharmaceuticals, Bayer AG, 13353 Berlin, Germany
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O’Sullivan JM, McKay RR, Rahbar K, Fizazi K, George DJ, Tombal B, Schmall A, Sandström P, Verholen F, Shore N. Real-world effectiveness, long-term safety and treatment pathway integration of radium-223 therapy in patients with metastatic castration-resistant prostate cancer. Front Med (Lausanne) 2022; 9:fmed-09-1070392. [PMID: 36619649 PMCID: PMC9812947 DOI: 10.3389/fmed.2022.1070392] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
Radium-223 dichloride (223Ra) is an α-emitter approved for the treatment of metastatic castration-resistant prostate cancer (mCRPC) with bone metastases, but without visceral involvement. Despite being a life-prolonging therapy (LPT), 223Ra remains underutilized. A large body of real-world evidence (RWE) for 223Ra has been published in the decade since the pivotal phase 3 ALSYMPCA study, a period during which the treatment landscape has continued to evolve. How to optimize 223Ra use, including how to integrate it into the mCRPC management pathway amongst other current LPTs (i.e., with respect to timing and concurrent, layered, or sequential use), is therefore of considerable interest. RWE studies lack the conventional restraints of clinical trials and can therefore help to build an understanding of how treatments may be best used in routine practice. Here we review RWE studies investigating the efficacy and safety of 223Ra in mCRPC [including in sequence with the recently approved 177-Lutetium conjugated to the ligand prostate-specific membrane antigen (177Lu-PSMA)], as well as response marker development, imaging techniques, and current clinical practice recommendations.
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Affiliation(s)
- Joe M. O’Sullivan
- Patrick G. Johnston Centre for Cancer Research, Queen’s University Belfast and Northern Ireland Cancer Centre, Belfast, United Kingdom
| | - Rana R. McKay
- Division of Hematology-Oncology, Department of Medicine, University of California, San Diego, La Jolla, CA, United States
| | - Kambiz Rahbar
- Department of Nuclear Medicine, University of Münster Medical Center, Münster, Germany
| | - Karim Fizazi
- Institut Gustave Roussy, University of Paris-Saclay, Villejuif, France
| | | | - Bertrand Tombal
- Division of Urology, Institut de Recherche Clinique (IREC), Cliniques Universitaires Saint Luc, Brussels, Belgium
| | | | - Per Sandström
- Bayer HealthCare Pharmaceuticals, Whippany, NJ, United States
| | | | - Neal Shore
- Carolina Urologic Research Center, Myrtle Beach, SC, United States
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Jores C, König F, Hellmis E, Grund C, Klier J, Zillmann R, Eichenauer R, Schönfelder R, Johannsen M, Schröder J, Hempel E, Doehn C. [Retrospective practice-related care research study on therapy of mCPRC with radium-223 dichloride]. Aktuelle Urol 2022; 53:511-516. [PMID: 36167310 DOI: 10.1055/a-1909-1018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
During phase III study ERA-223, patients under combination therapy with radium-223 and abiraterone showed an increased risk of bone fractures and a possible higher risk of death. This observation led to a change in the German therapeutic guidelines in 2018. Radium-223 is now only allowed as a third-line monotherapy (besides ADT) in patients with metastatic castration resistant prostate cancer (mCRPC) with symptomatic bone lesions without known visceral metastases or for patients with mCRPC, for whom no other available systematic therapy is suitable. Since almost no data on practice-related care research on the use of radium-223 exist, we consulted members of d-uo (German Uro-Oncologists) over their therapy algorithms. This study analysed data of patients treated with radium-223 between 2014 and 2019. It could be shown that 50% of mCRPC-patients had received radium-223 in the past as third-line therapy. Half of these were treated in combination with new androgen receptor targeted therapies (ARTA) and no increase in bone fractures was observed. This was most likely due to the additional use of bone protecting agents. Despite the late cancer stage, treatment response was seen in almost half of the patients.
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Affiliation(s)
- Charlotte Jores
- Urologie, Vivantes Netzwerk für Gesundheit GmbH, Berlin, Germany
| | - Frank König
- Urology, Otto von Guericke Universität Magdeburg, Magdeburg, Germany
| | - Eva Hellmis
- Praxis Walsum, Urologicum Duisburg, Duisburg, Germany
| | | | - Jörg Klier
- Urologie, Urologie Bayenthal in Köln, Köln, Germany
| | | | | | | | | | | | - Elke Hempel
- d-uo, SMGF Forschungsgesellschaft, Berlin, Germany
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Early alkaline phosphatase dynamics as biomarker of survival in metastatic castration-resistant prostate cancer patients treated with radium-223. Eur J Nucl Med Mol Imaging 2021; 48:3325-3334. [PMID: 33686456 PMCID: PMC8426246 DOI: 10.1007/s00259-021-05283-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 02/23/2021] [Indexed: 01/06/2023]
Abstract
Purpose Radium-223 is a life-prolonging therapy for castration-resistant prostate cancer (CRPC) patients with symptomatic bone metastases. However, validated biomarkers for response monitoring are lacking. The study aim was to investigate whether early alkaline phosphatase (ALP) dynamics after the first radium-223 injection can act as surrogate marker for overall survival (OS). Methods This retrospective multicenter study included consecutive CRPC patients treated with radium-223. Patients were divided into four subgroups based on baseline ALP level (normal/elevated) and early ALP response, defined as ≥10% ALP decrease after the first radium-223 injection. Primary endpoint was OS among the subgroups. Secondary endpoints included time to first skeletal-related event, time to ALP progression, and treatment completion rate. Results A total of 180 patients were included for analysis. Median OS was 13.5 months (95% confidence interval 11.5–15.5). Patients with elevated baseline ALP without ALP response after the first injection had significantly worse OS when compared to all other patients (median OS 7.9 months versus 15.7 months, hazard ratio 2.56, 95% confidence interval 1.73–3.80, P < 0.001). Multivariate analysis demonstrated that elevated baseline ALP without ALP response after the first injection, the number of prior systemic therapies, baseline LDH level, and baseline ECOG performance status were prognostic factors of OS. Patients with elevated baseline ALP without ALP response after the first injection had significantly shorter times to ALP progression and first skeletal-related event, and more frequently discontinued radium-223 therapy when compared to other patients. Conclusion Early treatment–induced changes in ALP after one radium-223 injection were associated with OS in metastatic CRPC patients.
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Caffo O, Frantellizzi V, Monari F, Sbrana A, Costa RP, Pinto C, Tucci M, Baldari S, Facchini G, Bortolus R, Alongi F, Alongi P, Palermo A, Fanti S, Biasco E, Murabito A, Filice A, Zichi C, Pignata S, Borsatti E, Salgarello M, Spada M, Cortesi E, Vincentis GD. Sequencing radium 223 and other life-prolonging agents in castration-resistant prostate cancer patients. Future Oncol 2021; 17:807-815. [PMID: 33508980 DOI: 10.2217/fon-2020-0391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Radium 223 (RA223) is currently administered as part of a therapeutic sequence with the other life-prolonging agents (LPAs) for metastatic castration-resistant prostate cancer (mCRPC). Patients & methods: We retrospectively reviewed the clinical records of patients who had received at least three LPAs including RA223. Results: Median overall survival (OS) from the start of first-line treatment was 39.8 months, with the patients who completed all six planned courses of RA223 having a longer OS than those who did not (53.2 vs 29.5 months; p < 0.0001). Conclusions: Our study confirms the activity of RA223 regardless of the treatment line in which it is administered and suggests that patient selection plays a central role in maximizing this activity.
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Affiliation(s)
- Orazio Caffo
- Department of Medical Oncology, Santa Chiara Hospital, Largo Medaglie d'Oro, 38122, Trento, Italy
| | - Viviana Frantellizzi
- Department of Radiological, Oncological & Anatomo-Pathological Sciences, La Sapienza University, Viale del Policlinico 155, 00161, Rome, Italy
| | - Fabio Monari
- Department of Radiotherapy, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti, 9, 40138, Bologna, Italy
| | - Andrea Sbrana
- Department of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Via Roma, 67, 56126, Pisa, Italy
| | - Renato Patrizio Costa
- Department of Nuclear Medicine, Policlinico Universitario, Via del Vespro, 129, 90127, Palermo, Italy
| | - Carmine Pinto
- Medical Oncology Unit, Clinical Cancer Centre, Azienda USL-IRCCS di Reggio Emilia, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Marcello Tucci
- Department of Medical Oncology, Cardinal Massaia Hospital Corso Dante Alighieri, 202, 14100, Asti, Italy
| | - Sergio Baldari
- Department of Biomedical & Dental Sciences & Morphological & Functional Images, University of Messina, Via Consolari Valeria 98125, Messina, Italy
| | - Gaetano Facchini
- Department of Medical Oncology, S.M. delle Grazie Hospital, Via Domitiana, 80078 Pozzuoli (NA), Italy
| | - Roberto Bortolus
- Department of Radiation Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Via F. Gallini 2, 33081, Aviano, Italy
| | - Filippo Alongi
- Advanced Radiation Oncology Department, IRCCS Ospedale Sacro Cuore Don Calabria, Via Don A. Sempreboni, 5, 37024, Negrar, Italy
| | - Pierpaolo Alongi
- Department of Radiological Sciences, Nuclear Medicine Service, Fondazione Istituto G. Giglio, Via Pisciotto, 90015, Cefalù, Italy
| | - Antonio Palermo
- Department of Nuclear Medicine Oncology, Santa Chiara Hospital, Largo Medaglie d'Oro, 38122, Trento, Italy
| | - Stefano Fanti
- Department of Nuclear Medicine Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti, 9, 40138, Bologna, Italy
| | - Elisa Biasco
- Azienda Ospedaliera Toscana Nord Ovest, UO Oncologia medica, Sezione Piombino/Elba, via San Rocco, Portoferraio Isola d'Elba, Italy
| | - Alessandra Murabito
- Department of Nuclear Medicine, Policlinico Universitario, Via del Vespro, 129, 90127, Palermo, Italy
| | - Angelina Filice
- Department of Nuclear Medicine, Azienda USL-IRCCS di Reggio Emilia, Viale Risorgimento, 80, 42123 Reggio Emilia, Italy
| | - Clizia Zichi
- Department of Medical Oncology, San Luigi Gonzaga Hospital, Regione Gonzole, 10, 10043, Orbassano, Italy
| | - Salvatore Pignata
- Department of Biomedical & Dental Sciences & Morphological & Functional Images, University of Messina, Via Consolari Valeria 98125, Messina, Italy
| | - Eugenio Borsatti
- Department of Nuclear Medicine, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Via F. Gallini 2, 33081, Aviano, Italy
| | - Matteo Salgarello
- Department of Nuclear Medicine Oncology, IRCCS Ospedale Sacro Cuore Don Calabria, Via Don A. Sempreboni, 5, 37024, Negrar, Italy
| | - Massimiliano Spada
- Department of Medical Oncology, Fondazione Istituto G. Giglio, Via Pisciotto, 90015, Cefalù, Italy
| | - Enrico Cortesi
- Department of Radiological, Oncological & Anatomo-Pathological Sciences, La Sapienza University, Viale del Policlinico 155, 00161, Rome, Italy
| | - Giuseppe De Vincentis
- Department of Radiological, Oncological & Anatomo-Pathological Sciences, La Sapienza University, Viale del Policlinico 155, 00161, Rome, Italy
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