Role of Radium-223 in the Treatment of Metastatic Castration Resistant Prostate Cancer (mCRPC): Clinical Practice and Future Perspectives

Emilio Bombardieri, Giovanni Luca Ceresoli, Lucia Setti, Maria Bonomi, Elisa Villa, Gianluigi Ciocia, Riccardo Vicinelli and Laura Evangelista

Department of Nuclear Medicine, Humanitas Gavazzeni, Bergamo, Italy
Department of Clinical Oncology, Humanitas Gavazzeni, Bergamo, Italy
Department of Radiotherapy, Humanitas Gavazzeni, Bergamo, Italy
Department of Nuclear Medicine, University Milano Bicocca, Italy
Department of Radiotherapy and Nuclear Medicine, 10V, Padova, Italy

^*Correspondance to: Emilio Bombardieri 

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Abstract:

The therapeutic landscape for patients with metastatic castration Resistant prostate cancer (mCRPC) has rapidly changed in the last 5 years. New hormonal, cytotoxic and immunological agents have been introduced demonstrating efficacy both in terms of cancer control and survival improvement. 223Ra-dichloride (Radium-223) is a calcium-mimetic alpha emitting radiopharmaceutical agent with a very high linear energy transfer, label to determine an irreversible damage in the DNA of cancer cells. In a large controlled randomized perspective clinical trial, Radium-223 provided interesting results in symptomatic mCRPC patients with bone metastases, by decreasing pain, delaying Skeletal Related Events (SREs) and improving the survival. Among a series of radiopharmaceuticals for the treatments of skeletal metastases (i.e., Strontium-89, Rhenium-186 and Samarium-153) in prostate cancer patients, Radium-223 is the first agent that demonstrated a favorable impact on both improvement of quality of life and overall survival. This overview discusses the current armamentarium available for mCRPC patients, focusing the attention on Radium-223, its selective uptake in bone metastases, the safety profile and the open questions related to its use in clinical practice, such as the doses and the number of cycles of treatment. Moreover, being the mechanism of Radium-223 action not potentially in overlap with any other available treatments, it results suitable for both sequencing and combination studies. In the present paper, future perspectives are briefly discussed by the authors considering some possible associations of Radium-223 with other therapeutic agents that would improve the outcomes of patients without increasing toxicities, and by looking for its potential applications in the next future.

Keywords:

Castration Resistant Prostate Cancer; Bone metastases; Radium-223, Radio metabolic therapy

Cite the Article:

Bombardieri E, Ceresoli GL, Setti L, Bonomi M, Villa E, Ciocia G, et al. Role of Radium-223 in the Treatment of Metastatic Castration Resistant Prostate Cancer (mCRPC): Clinical Practice and Future Perspectives. Clin Oncol. 2016;1: 1173.