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Anido-Herranz U, Fernandez-Calvo O, Ruiz-Bañobre J, Martinez-Breijo S, Fernandez-Nuñez N, Nogareda-Seoane Z, Garrido-Pumar M, Casas-Nebra J, Muñiz-Garcia G, Portela-Pereira P, Gomez-Caamaño A, Perez-Fentes DA, Santome-Couto L, Lázaro M, Molina-Diaz A, Medina-Colmenero A, Vazquez-Estevez S. Outcomes and patterns of use of Radium-223 in metastatic castration-resistant prostate cancer. Front Oncol 2024; 14:1385466. [PMID: 38774416 PMCID: PMC11106362 DOI: 10.3389/fonc.2024.1385466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 04/09/2024] [Indexed: 05/24/2024] Open
Abstract
Introduction Radium-223 dichloride (Ra-223) is recommended as a treatment option for metastatic castration-resistant prostate cancer (mCRPC) patients with symptomatic bone metastases and no visceral disease, after docetaxel failure, or in patients who are not candidates to receive it. In this study, we aimed to ambispectively analyze overall survival (OS) and prognostic features in mCRPC in patients receiving Ra-223 as per clinical routine practice and identify the most suitable treatment sequence. Patients and methods This study is observational, multicentric, and ambispective. Eligibility criteria included mCRPC patients treated with Ra-223, with an Eastern Cooperative Oncology Group (ECOG) performance status of 0-2, without visceral metastases, and no more than three cm involved lymph nodes. Results A total of 145 patients were included; the median age was 73.97 years, and a Gleason score of more than or equal to 7 in 61 (48%) patients; 73 (81%) had previously received docetaxel. The most important benefit was reached by those patients who received Ra-223 in the second-line setting, with a median OS of 17 months (95% CI, 12-21), and by patients who received six cycles of treatment, with a median OS of 19 months (95% CI, 14-21). An alkaline phosphatase (ALP) decrease was also identified as a prognosis marker. When performing the multivariate analysis, the time to develop castration-resistant disease longer than 24 months was the most important prognostic factor to predict the evolution of the patients receiving Ra-223. Ra-223 was well tolerated, with thrombocytopenia, anemia, and diarrhea being the main adverse events. Conclusion There is a benefit for those patients who received Ra-223 in the second-line setting, regardless of prior use of docetaxel. In addition, a survival benefit for patients presenting with a decline in ALP was observed.
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Affiliation(s)
- Urbano Anido-Herranz
- Translational Medical Oncology Group (ONCOMET), Health Research Institute of Santiago de Compostela (IDIS), University Clinical Hospital of Santiago de Compostela, University of Santiago de Compostela (USC), Santiago de Compostela, Spain
- Department of Medical Oncology, University Clinical Hospital of Santiago de Compostela (SERGAS), University of Santiago de Compostela (USC), Santiago de Compostela, Spain
| | | | - Juan Ruiz-Bañobre
- Translational Medical Oncology Group (ONCOMET), Health Research Institute of Santiago de Compostela (IDIS), University Clinical Hospital of Santiago de Compostela, University of Santiago de Compostela (USC), Santiago de Compostela, Spain
- Department of Medical Oncology, University Clinical Hospital of Santiago de Compostela (SERGAS), University of Santiago de Compostela (USC), Santiago de Compostela, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto de Salud Carlos III, Madrid, Spain
| | - Sara Martinez-Breijo
- Department of Urology, University Clinical Hospital of A Coruña, A Coruña, Spain
| | | | - Zulema Nogareda-Seoane
- Department of Nuclear Medicine, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Miguel Garrido-Pumar
- Department of Nuclear Medicine, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Gloria Muñiz-Garcia
- Department of Nuclear Medicine – GALARIA, Complexo Hospitalario Universitario Ourense A. S. de Ourense, Ourense, Spain
| | | | - Antonio Gomez-Caamaño
- Department of Radiation Oncology, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Daniel Adolfo Perez-Fentes
- Department of Urology, EOXI University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Martín Lázaro
- Department of Medical Oncology, Álvaro Cunqueiro Hospital, Vigo, Spain
| | - Aurea Molina-Diaz
- Department of Medical Oncology, University Clinical Hospital of A Coruña, A Coruña, Spain
| | - Ana Medina-Colmenero
- Department of Medical Oncology, Fundación Centro Oncológico de Galicia, A Coruña, Spain
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Xiong X, Zhang S, Zheng W, Liao X, Yang J, Xu H, Hu S, Wei Q, Yang L. Second-line treatment options in metastatic castration-resistant prostate cancer after progression on first-line androgen-receptor targeting therapies: A systematic review and Bayesian network analysis. Crit Rev Oncol Hematol 2024; 196:104286. [PMID: 38316286 DOI: 10.1016/j.critrevonc.2024.104286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 01/22/2024] [Accepted: 01/31/2024] [Indexed: 02/07/2024] Open
Abstract
OBJECTIVE To summarize and indirectly compare the efficacy and safety of different second-line systematic therapies after first-line androgen-receptor targeting therapies (ARTs) for biomarker-unselected metastatic castration-resistant prostate cancer (mCRPC) patients. METHODS Studies published in English up to May 2023 were identified in PubMed, Web of Science and ASCO-GU 2023. Studies accessing the efficacy and safety of second-line systematic therapies after first-line ARTs for biomarker-unselected mCRPC patients were eligible for current systematic review and network meta-analysis (NMA). RESULTS Thirty-two studies with 5388 patients and 10 unique treatment modalities met our inclusion criteria. Current evidence suggested that docetaxel (DOC) combined with the same ART as first-line (ART1) (ART1 + DOC) were associated with significantly improved PSA response, PSA progression-free survival (PFS) and clinical or radiographic PFS (rPFS) compared with other reported second-line systematic therapies, including DOC. An increase in toxicity was observed with ART1 + DOC. Our NMA indicated that DOC monotherapy was only inferior to ART1 + DOC in improvement disease outcomes. The incidence of toxicity between patients received second-line DOC and an alternative ART (ART2) was similar. CONCLUSION The available evidence reviewed in our work suggested a clinical benefit of DOC nomotherapy and DOC plus ART1 as the second-line systematic therapy for biomarker-unselected mCRPC patients progressed on a first-line ART. More studies and RCTs are needed to evaluate the optimal second-line treatments for mCRPC patients with one prior first-line ART.
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Affiliation(s)
- Xingyu Xiong
- Department of Urology, West China Hospital of Sichuan University, 610000 Chengdu, Sichuan Province, China; Institute of Urology, West China Hospital of Sichuan University, 610000 Chengdu, Sichuan Province, China
| | - Shiyu Zhang
- Department of Urology, West China Hospital of Sichuan University, 610000 Chengdu, Sichuan Province, China; Institute of Urology, West China Hospital of Sichuan University, 610000 Chengdu, Sichuan Province, China
| | - Weitao Zheng
- Department of Urology, West China Hospital of Sichuan University, 610000 Chengdu, Sichuan Province, China; Institute of Urology, West China Hospital of Sichuan University, 610000 Chengdu, Sichuan Province, China
| | - Xinyang Liao
- Department of Urology, West China Hospital of Sichuan University, 610000 Chengdu, Sichuan Province, China; National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, 610000 Chengdu, Sichuan Province, China
| | - Jie Yang
- Department of Urology, West China Hospital of Sichuan University, 610000 Chengdu, Sichuan Province, China; Institute of Urology, West China Hospital of Sichuan University, 610000 Chengdu, Sichuan Province, China
| | - Hang Xu
- Department of Urology, West China Hospital of Sichuan University, 610000 Chengdu, Sichuan Province, China; National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, 610000 Chengdu, Sichuan Province, China
| | - Siping Hu
- National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, 610000 Chengdu, Sichuan Province, China
| | - Qiang Wei
- Department of Urology, West China Hospital of Sichuan University, 610000 Chengdu, Sichuan Province, China; National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, 610000 Chengdu, Sichuan Province, China.
| | - Lu Yang
- Department of Urology, West China Hospital of Sichuan University, 610000 Chengdu, Sichuan Province, China; Institute of Urology, West China Hospital of Sichuan University, 610000 Chengdu, Sichuan Province, China.
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Zacchi F, Carles J, Gonzalez M, Maldonado X, Perez-Lopez R, Semidey ME, Mateo J. Case report: Exceptional and durable response to Radium-223 and suspension of androgen deprivation therapy in a metastatic castration-resistant prostate cancer patient. Front Oncol 2024; 14:1331643. [PMID: 38525428 PMCID: PMC10959003 DOI: 10.3389/fonc.2024.1331643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 02/01/2024] [Indexed: 03/26/2024] Open
Abstract
Despite the development of new therapies in the last few years, metastatic prostate cancer (PCa) is still a lethal disease. Radium-223 (Ra-223) is approved for patients with advanced castration-resistant prostate cancer (CRPC) with bone metastases and no visceral disease. However, patients' outcomes are heterogenous, and there is lack of validated predictive biomarkers of response, while biomarkers for early identification of patients who benefit from treatment are limited. This case report describes a remarkable and durable response to Ra-223 in a CRPC patient with bone metastases who had rapidly progressed to many previous therapies; this response is now lasting for 5 years even after having stopped backbone androgen deprivation therapy (ADT). Here, we present the clinical course of this exceptional response, as well as comprehensive genomic and histopathology analyses on sequential biopsies acquired before and after therapy. Additionally, we review current knowledge on predictive and response biomarkers to Ra-223 in metastatic prostate cancer.
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Affiliation(s)
- Francesca Zacchi
- Section of Innovation Biomedicine-Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona and University and Hospital Trust (AOUI) of Verona, Verona, Italy
- Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Joan Carles
- Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
- Vall d’Hebron University Hospital, Barcelona, Spain
| | - Macarena Gonzalez
- Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
- Vall d’Hebron University Hospital, Barcelona, Spain
| | - Xavier Maldonado
- Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
- Vall d’Hebron University Hospital, Barcelona, Spain
| | | | | | - Joaquin Mateo
- Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
- Vall d’Hebron University Hospital, Barcelona, Spain
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Thellenberg-Karlsson C, Vjaters E, Kase M, Tammela T, Ojamaa K, Norming U, Nyman C, Andersson SO, Hublarovs O, Marquez-Holmberg M, Castellanos E, Ullen A, Holmberg A, Nilsson S. A randomised, double-blind, dose-finding, phase II multicentre study of ODX in the treatment of patients with castration-resistant prostate cancer and skeletal metastases. Eur J Cancer 2023; 181:198-207. [PMID: 36682096 DOI: 10.1016/j.ejca.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 12/01/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022]
Abstract
AIMS This study aimed to assess the efficacy and safety of ODX, a novel, cytotoxic, bone-targeting drug candidate, in castration-resistant prostate cancer bone metastatic disease. METHODS Patients with progressive disease were randomised to ten cycles of ODX, intravenous infusion Q2W (3, 6, and 9 mg/kg, respectively). The primary objective was to assess the relative change from baseline in bone alkaline phosphatase (B-ALP) and serum-aminoterminal-propeptide of Type I procollagen (S-P1NP) at 12 weeks. The inclusion criteria selected were broad, and a double-blind design was used to ensure objective recruitment of patients for the assessment of efficacy. None of the patients received bone-protecting agents during the ODX treatment period. RESULTS Fifty-five 21,20 and 14) patients were randomised to ODX (3, 6 and 9 mg/kg), respectively. The lower number of patients in arm 3 was due to too low a recruitment rate towards the end of the study. The median treatment time were 14, 13 and 14 weeks, respectively. The decrease in B-ALP at 12 weeks in study arms 3, 6 and 9 mg/kg was seen in 6/15 (40%), 8/12 (67%) and 5/12 (42%) patients, respectively, whereas the corresponding numbers for P1NP were 8/15 (53%), 8/12 (67%), and 4/12 (33%), respectively. The median decrease in B-ALP and P1NP at 12 weeks for study arms 3, 6 and 9 mg/kg were 37%, 14% and 43%, respectively, and 51%, 40% and 64%, respectively. The decrease in serum C-terminal telopeptide at 12 weeks was seen in the vast majority of patients and in about one-third of patients in bone scan index. ODX was well tolerated, and no drug-related serious adverse events occurred. There were no significant differences between study arms regarding efficacy and safety. CONCLUSIONS ODX was well tolerated and demonstrated inhibitory effects on markers related to the vicious cycle in bone at all three doses. The reduction in metastatic burden, assessed with bone scan index, supports this finding. Studies with continued ODX treatment until disease progression are being planned (ClinicalTrials.gov Identifier: NCT02825628).
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Affiliation(s)
| | - Egils Vjaters
- Pauls Strandis Clinical University Hospital, Pilsonu Iela 13, Riga, Latvia.
| | - Marju Kase
- Tartu University Hospital, L.Puusepa 8, Tartu, Estonia.
| | - Teuvo Tammela
- Tampere University Hospital, Urology Clinic, Teiskontie 35, Tampere, Finland.
| | | | - Ulf Norming
- Department of Clinical Science and Education, Karolinska Institutet and Södersjukhuset, Stockholm, Sweden.
| | - Claes Nyman
- Department of Clinical Science and Education, Karolinska Institutet and Södersjukhuset, Stockholm, Sweden.
| | | | | | | | | | - Anders Ullen
- Department of Oncology-Pathology, Karolinska Institutet, 17164 Solna.
| | - Anders Holmberg
- Department of Oncology-Pathology, Karolinska Institutet, 17164 Solna; Dextech Medical, Box 389, 751 06 Uppsala.
| | - Sten Nilsson
- Department of Oncology-Pathology, Karolinska Institutet, 17164 Solna.
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