Quantifying the survival benefit of completing all the six cycles of radium-223 therapy in patients with castrate-resistant prostate cancer with predominant bone metastases

Abstract

A retrospective analysis was performed of epidemiological data assessing the survival of patients who had received radium-223 for castrate-resistant metastatic prostate cancer treated at a regional tertiary referral center over a 5-year period. The patients' age, date of first treatment, and the number of cycles of radium-223 given were obtained from the patients' electronic patient record (EPR). Data on the date of death were provided by national death registrations which update the EPR via a unique national health service number. A total of 187 patients (mean age on the date of first treatment: 73 years; range: 56–93) were treated from April 1, 2014, to June 30, 2019. The median overall survival of the 119 patients (71%) who had died by December 31, 2019, was 15 months. There was no significant age difference between those who had died and survivors (72 vs. 74 years). On a further analysis, it was found that the median overall survival of the 107 patients who had received all the six cycles of radium-223 was 31 months, significantly longer than the median overall survival of only 6 months for those eighty patients who had received less than the full course of six cycles of radium-223 ( P = 0.001). Of those who received all the six cycles of treatment, 58 patients had died (58%) and the 1-year survival was 87%. This was compared to the group of patients receiving <6 cycles of radium-223 where 61 patients (76%) had died and the 1-year survival was 30%. Therefore, the hazard ratio of dying before 1 year if the patient did not receive all the six cycles of treatment was 2.9. Where the reason for stopping treatment was recorded on the EPR the most common cause for the cessation of treatment was because of the side effects caused by the treatment itself. Other causes were hospitalization with comorbidities, disease progression, or patient choice. Given the survival advantage of receiving the full course of all the six cycles of treatment, this should be administered if possible and the patients should be managed in such a way as to allow the complete treatment course to be given.

Prognostic Value of the BIO-Ra Score in Metastatic Castration-Resistant Prostate Cancer Patients Treated with Radium-223 after the European Medicines Agency Restricted Use: Secondary Investigations of the Multicentric BIO-Ra Study

“…In the present analysis, we verified whether the prognostic power of the BIO-Ra score is still preserved in light of the EMA restriction of the use of Ra-223. Moreover, we verified the correlation between the BIO-Ra score and treatment completion, which is a well-known prognostic factor in mCRPC patients treated with Ra-223 [ 20 , 21 , 22 , 23 , 24 ].…”

“…This finding is coherent with the observed prediction of treatment completion by the BIO-Ra score in the same time interval. Indeed, several previous studies showed a substantial survival benefit in patients reaching the completion of Ra-223 cycles [ 20 , 21 , 22 , 23 , 24 ].…”

Survival outcomes of radium-223 therapy for metastatic castration-resistant prostate cancer following national health insurance reimbursement in Taiwan

“…Notably, the self-pay group had lower at baseline serum Hb levels ( p = 0.0036). Buscombe et al 28 reported a median OS of 15 months for patients who completed six cycles of Ra-223 compared to 8 months for patients who completed fewer than six cycles. In the ALSYMPCA trial, the median OS for patients who underwent one to four cycles of Ra-223 was 6.2 months versus 17.9 months for patients who received five to six cycles, indicating that administering four or fewer cycles provides minimal survival benefit.…”

Real-world patient characteristics associated with survival of 2 years or more after radium-223 treatment for metastatic castration-resistant prostate cancer (EPIX study)

“…These results also indicate that radium-223, as appropriate, could be considered as one of the early treatment options integrated into the management of patients with mCRPC, with no apparent adverse impact on long-term prognosis. Other real-world studies have shown correlations between overall survival and completion of 5 or 6 radium-223 injections, use of radium-223 in the first or second line, or use before chemotherapy [11][12][13][14][15][16][17][18]. Patients able to complete the full course of radium-223 injections are likely to have fewer symptoms (including less pain), less disease burden, a good performance status, low baseline PSA and ALP levels, and high baseline hemoglobin levels [11,[19][20][21][22][23].…”