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Inicio Actas Urológicas Españolas (English Edition) Radium-223 for the treatment of metastatic castration-resistant prostate cancer:...
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Vol. 42. Issue 10.
Pages 616-624 (December 2018)
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Vol. 42. Issue 10.
Pages 616-624 (December 2018)
Review article
DOI: 10.1016/j.acuroe.2018.10.005
Radium-223 for the treatment of metastatic castration-resistant prostate cancer: A window of opportunity
Radio-223 en el tratamiento del cáncer de próstata resistente a la castración metastásico: una ventana de oportunidad
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F. Gómez-Veigaa,
Corresponding author
fgveiga@telefonica.net

Corresponding author.
, J.L. Álvarez-Ossoriob, J. Carballido-Rodríguezc, A. Juárez-Sotod, A. Rodríguez-Antolíne, J.M. Cozar-Olmof
a Hospital Clínico Universitario de Salamanca, Salamanca, Spain
b Hospital Puerta del Mar, Cádiz, Spain
c Hospital Puerta de Hierro, Majadahonda, Madrid, Spain
d Hospital de Jerez, Jerez de la Frontera, Cádiz, Spain
e Hospital 12 de Octubre, Madrid, Spain
f Hospital Virgen de las Nieves, Granada, Spain
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Table 1. Presence of pain and visceral metastases in the pivotal studies of abiraterone, enzalutamide, and radium-223. Relationship with overall survival.
Table 2. Periodic assessments in the monitoring of the patient treated with radium-223.
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Abstract
Context

The elimination of bone metastases, restoration and/or preservation of bone morphology and prevention and/or delay of skeletal events are a fundamental objective in the management of metastatic castration-resistant prostate cancer (mCRPC). Radium-223 is the first targeted alpha therapy with effects on bone that has been shown to increase survival in these patients, besides providing other bone-related benefits.

Objective

To analyze the impact of bone metastasis on mCRPC, and the benefits and the window of opportunity provided by radium-223 in the treatment of patients with mCRPC in the current treatment era.

Evidence acquisition

A bibliographic search of PubMed and Spanish and international congresses on radium-223 and other first-line treatments for mCRPC was performed. Recent guidelines and recommendations by experts were also consulted.

Summary of the evidence

Evidence for the mechanism of action of radium-223 widen its effects to the tumor bone environment. Survival of patients treated with radium-223 is higher in those with mild symptoms as opposed to those with moderate-severe symptoms. The presence of visceral metastases even in the early stages of mCRPC supports starting radium-223 therapy before the symptoms become clinically relevant. A 3-year study has confirmed its good safety profile. Changes in tALP and LDH may be useful markers for monitoring the treatment with radium-223, but they are not predictors of overall survival.

Conclusion

Radium-223 is a valuable therapeutic alternative in the treatment of patients with mCRPC in early stages of the disease, with a good safety profile. Its benefits extend to the bone environment.

Keywords:
Prostate cancer
Metastatic castration-resistant prostate cancer
Radium-223
Targeted alpha therapy
Mode of action
Resumen
Contexto

Eliminar las metástasis óseas, restaurar/preservar la morfología ósea y prevenir/retrasar los eventos óseos constituyen un objetivo fundamental en el manejo del cáncer de próstata resistente a la castración metastásico (CPRCm). Radio-223 es la primera terapia alfa-dirigida con acción sobre el hueso que aumenta la supervivencia en estos pacientes, además de mostrar otros beneficios sobre los eventos óseos.

Objetivo

Analizar el impacto de las metástasis óseas en el CPRCm, así como los beneficios y la ventana de oportunidad ofrecida por radio-223 en el tratamiento de pacientes con CPRCm en el contexto terapéutico actual.

Adquisición de la evidencia

Búsqueda bibliográfica en PubMed y congresos nacionales/internacionales sobre radio-223 y otros tratamientos en primera línea para el CPRCm. Se consultaron guías y recomendaciones de expertos recientes.

Resumen de la evidencia

La evidencia acerca del mecanismo de acción de radio-223 amplía su efecto al entorno óseo del tumor. La supervivencia en pacientes tratados con radio-223 es superior en aquellos con síntomas leves respecto a moderados-graves. La aparición de metástasis viscerales incluso en fases tempranas del CPRCm apoya comenzar el tratamiento con radio-223 antes incluso de que los síntomas sean clínicamente relevantes. Un estudio a 3 años ha confirmado su buen perfil de seguridad. Los cambios de tALP y LDH podrían constituir marcadores útiles para la monitorización, aunque no son predictores de la supervivencia global.

Conclusión

Radio-223 ofrece un alternativa terapéutica valiosa en el tratamiento de pacientes con CPRCm en fases tempranas de la enfermedad, con buen perfil de seguridad. Su beneficio se extiende al entorno óseo.

Palabras clave:
Cáncer de próstata
Cáncer de próstata resistente a la castración metastásico
Radio-223
Terapias alfa-dirigidas
Mecanismo de acción

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