Practical recommendations for radium-223 treatment of metastatic castration-resistant prostate cancer

Abstract

PurposeRadium Ra 223 dichloride (radium-223, Xofigo®) is the first targeted alpha therapy for patients with castration-resistant prostate cancer and symptomatic bone metastases. Radium-223 provides a new treatment option for this setting, but also necessitates a new treatment management approach. We provide straightforward and practical recommendations for European nuclear medicine centres to optimize radium-223 service provision.MethodsAn independent research consultancy agency observed radium-223 procedures and conducted interviews with all key staff members involved in radium-223 treatment delivery in 11 nuclear medicine centres across six countries (Germany, Italy, the Netherlands, Spain, Switzerland and the UK) experienced in administering radium-223. The findings were collated and discussed at a meeting of experts from these centres, during which key consensus recommendations were defined.ResultsThe recommendations cover centre organization and preparation; patient referral; radium-223 ordering, preparation and disposal; radium-223 treatment delivery/administration; and patient experience. Guidance includes structured coordination and communication within centres and multidisciplinary teams, focusing on sharing best practice to provide high-quality, patient-centred care throughout the treatment pathway.ConclusionsThese expert recommendations are intended to complement existing management guidelines. Sharing best practice and experience will help nuclear medicine centres to optimize radium-223 service provision and improve patient care.

Primary Radical Prostatectomy or Ablative Radiotherapy as Protective Factors for Patients With mCRPC Treated With Radium-223 Dichloride: An Italian Multicenter Study

“…Conventional analgesics and glucocorticoids were administered to control pain, as prescribed by the best standard of care. 223-Ra has been administered according to the Italian current label authorization 14 . At least one cycle of radionuclide therapy with 223-Ra was required for the enrollment.…”

Realising the potential of radioligand therapy: policy solutions for the barriers to implementation across Europe

“…Radioligand therapy may provide life-enhancing treatment for patients with cancer who have limited therapeutic options. To ensure it can be appropriately embedded into cancer care, greater integration of nuclear medicine into models of care, workforce planning and hospital resourcing is needed [14,15,26]. At a policy level, the inclusion of radioligand therapy in cancer-related policies and future cancer plans-such as Europe's Beating Cancer Plan-will also be essential, as will be proactively addressing healthcare system capacity issues to enable the provision of safe, high-quality care for both inpatients and outpatients across settings.…”

“…The provision of radioligand therapy requires intensive planning with clear workflows and processes [10,14,15]. New processes around radioligand therapy may be disruptive to current cancer care pathways, which may be a barrier in itself [10].…”

“…Furthermore, regulatory frameworks do not fully account for differences between radioisotopes, for example, between diagnostic radioisotopes and therapeutic radioisotopes in which alpha or beta radiation is the main energy carrier. Such rigid frameworks can restrict the use of certain types of radioligand therapy and affect who provides treatment and how [11,15,22]. Both international and national regulatory frameworks developed for conventional medicines may need to be adapted to be appropriate for the evaluation of radioligand therapy and radioisotopes [23].…”

Sequential Therapy of Metastatic Castration-Resistant Prostate Cancer: New Possibilities

“…Таким образом, радий-223 создает дополнительную альтернативу для последовательной терапии мКРРПЖ и проведения большего количества линий. Независимые практические рекомендации, сформулированные по итогам консультаций 11 ведущих медицинских центров из 6 стран Европы, имеющих опыт применения радия-223, дали следующую характеристику идеальному кандидату для терапии радием-223: наличие ≥2 костных метастазов, наличие первых симптомов костных метастазов, лимфаденопатия менее 3 см в диаметре [30].…”