Intravenous radionuclide therapy with radium chloride [223Ra] in patients with bone metastases from castration-resistant prostate cancer

Purpose of the study. Assessment of clinical safety and effectiveness of radium‑223 in patients with bone metastases from castration-resistant prostate cancer.

Patients and methods. The study involved materials on 15 patients with bone metastases from castration-resistant prostate cancer aged 58–81 years, with the mean age of 67.2 ± 6.5 years, who were examined and received full treatment with 6 intravenous injections of radium‑223 chloride [223Ra] at the National Medical Research Centre for Oncology. Most patients (73.3 %) showed ECOG 1 performance status. Pain syndrome before the treatment was registered in 12 (80 %) patients.

Results. Evaluation of the tolerability of radium chloride did not show hematological reactions such as anemia and thrombocytopenia. One patient had grade II intestinal toxicity after the 3rd injection managed with medication. Assessment of indirect signs of the treatment effectiveness demonstrated that 6 people showed an increase in PSA during treatment, while alkaline phosphatase levels were within normal range indicating no bone destruction. 8 of 12 patients with pain syndrome showed its relief during the therapy. The following results were obtained during a follow-up examination after 3 months in 15 patients who received the full treatment course: stabilization in 8 patients; improvement in 4 patients with decreased metabolic activity and lower numbers of metastatic foci; progression with the appearance of new metastatic foci in the bones in 3 patients.

Conclusion. Radium chloride showed good results in the treatment of patients with bone metastases from castration-resistant prostate cancer. Low toxicity and improvement in the quality of life by pain relief make this treatment technique promising.

1. Malignant neoplasms in Russia in 2021 (morbidity and mortality). Ed. by A. D. Kaprin, V. V. Starinsky, A. O. Shakhzadova. Moscow: P. A. Herzen MNIOI – Branch of the National Medical Research Radiological Center, 2022, 252 p. (In Russ.)

2. Andreev DA, Zavyalov AA, Govorov AV, Kokushkin KA, Davydovskaya MV. Castration-resistant prostate cancer: new perspectives in pharmacological treatment. Russian Medical Journal. 2019;25(1):49–58. (In Russ.). https://doi.org/10.18821/0869-2106-2019-25-1-49-58, EDN: VPCCJR

3. Markova AS. Current possibilities of drug therapy for castration-resistant prostate cancer. Cancer Urology. 2013;9(2):73–77. (In Russ.). https://doi.org/10.17650/1726-9776-2013-9-2-73-77, EDN: RAMIBL

4. Gallaher J, Cook LM, Gupta S, Araujo A, Dhillon J, Park JY, et al. Improving treatment strategies for patients with metastatic castrate resistant prostate cancer through personalized computational modeling. Clin Exp Metastasis. 2014 Dec;31(8):991–999. https://doi.org/10.1007/s10585-014-9674-1

5. Kirby M, Hirst C, Crawford ED. Characterising the castration-resistant prostate cancer population: a systematic review. Int J Clin Pract. 2011 Nov;65(11):1180–1192. https://doi.org/10.1111/j.1742-1241.2011.02799.x

6. Matveev VB, Markova AS. Efficacy and safety of radium-223 in routine clinical practice. Cancer Urology. 2020;16(4):129–135. (In Russ.). https://doi.org/10.17650/1726-9776-2020-16-4-129-135, EDN: OVEGET

7. Mottet N, van den Bergh RCN, Briers E, Van den Broeck T, Cumberbatch MG, De Santis M, et al. EAU-EANM-ESTRO-ESURSIOG Guidelines on Prostate Cancer-2020 Update. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent. Eur Urol. 2021 Feb;79(2):243–262. https://doi.org/10.1016/j.eururo.2020.09.042

8. Keizman D, Fosboel MO, Reichegger H, Peer A, Rosenbaum E, Desax MC, et al. Imaging response during therapy with radium-223 for castration-resistant prostate cancer with bone metastases-analysis of an international multicenter database. Prostate Cancer Prostatic Dis. 2017 Sep;20(3):289–293. https://doi.org/10.1038/pcan.2017.6

9. Maksimova NA, Gusareva MA, Zinkovich MS, Faenson AV, Ilchenko MG, Kosheleva NG, et al. The first case of radium-223 use in patients with bone metastases of castration-resistant prostate cancer is a question of oncology. 2023;69(3S):232–233. (In Russ.). https://doi.org/10.37469/0507-3758-2023-69-3s1, EDN: SBQKBK

10. Kochetova TYu, Krylov VV, Petrosyan KM, Karyakin OB, Biryukov VA, Alekseev BYa, et al. Radium chloride [223Ra] for patients with prostate cancer and skeletal metastases. Clinical recommendations. Cancer Urology. 2020;16(1):114–123. (In Russ.). https://doi.org/10.17650/1726-9776-2020-16-1-114-123, EDN: UPRLFX

11. Kairemo K, Joensuu T, Rasulova N, Kiljunen T, Kangasmäki A. Evaluation of Alpha-Therapy with Radium-223-Dichloride in Castration Resistant Metastatic Prostate Cancer-the Role of Gamma Scintigraphy in Dosimetry and Pharmacokinetics. Diagnostics (Basel). 2015 Jul 30;5(3):358–368. https://doi.org/10.3390/diagnostics5030358

12. Xofigo (radium-223 dichloride). Summary of Product Characteristics. Bayer Inc., 2022. https://www.bayer.com/sites/default/files/xofigo-pm-en.pdf

13. Basch E, Loblaw DA, Oliver TK, Carducci M, Chen RC, Frame JN, et al. Systemic therapy in men with metastatic castration-resistant prostate cancer: American Society of Clinical Oncology and Cancer Care Ontario clinical practice guideline. J Clin Oncol. 2014 Oct 20;32(30):3436–3448. https://doi.org/10.1200/JCO.2013.54.8404