ALSYMPCA: alpha emitter radium-223 and survival in metastatic prostate cancer with bone metastases
Radium-223, an injected alpha-emitting radioisotope that homes to bone, lengthened survival and delayed skeletal complications in men with castration-resistant prostate cancer that had spread to bone but not to organs.
Overview
Phase 3 placebo-controlled trial of 921 men with castration-resistant prostate cancer, symptomatic bone metastases and no visceral disease, randomised 2:1 to six injections of radium-223 or placebo with best standard of care.
Median overall survival was 14.9 versus 11.3 months (hazard ratio 0.70), time to first symptomatic skeletal event was delayed (15.6 versus 9.8 months) and myelosuppression was mild.
- Median overall survival 14.9 vs 11.3 months; hazard ratio 0.70.
- Time to first symptomatic skeletal event 15.6 vs 9.8 months.
Radium-223 is an option for symptomatic bone-predominant castration-resistant prostate cancer, now less used since lutetium-PSMA, and should not be combined with abiraterone after the ERA 223 fracture signal.
- No effect on PSA or soft tissue disease.
- Combination with abiraterone increased fractures and deaths in ERA 223.
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