Heinrich Daniel, Bektic Jasmin, Bergman Andries M, Caffo Orazio, Cathomas Richard, Chi Kim N, Daugaard Gedske, Keizman Daniel, Kindblom Jon, Kramer Gero, Olmos David, Omlin Aurelius, Sridhar Srikala S, Tucci Marcello, van Oort Inge, Nilsson Sten
Department of Oncology, Akershus University Hospital, Lørenskog, Norway.
Department of Urology, Medical University Innsbruck, Innsbruck, Austria.
Clin Genitourin Cancer. 2017 Sep 6. doi: 10.1016/j.clgc.2017.08.020.
Radium-223 dichloride (radium-223) was approved for the treatment of patients with castration-resistant prostate cancer (CRPC) and symptomatic bone metastases in the United States and Europe in 2013. This followed a reported overall survival benefit for patients treated with radium-223 and best standard of care (BSoC) when compared with placebo and BSoC in the ALpharadin in SYMptomatic Prostate CAncer (ALSYMPCA) trial. At that time, docetaxel was the standard first-line choice for patients with metastatic CRPC (mCRPC). Since then, the treatment landscape has changed dramatically with new hormonal agents (abiraterone and enzalutamide) considered to be the first-line choice for many patients. The optimal patient profile for radium-223 in the modern setting, and its best use either in sequence or in combination with other approved agents are unclear, with few definitive guidelines available. This article reports on the views of a group of urologists and medical oncologists experienced in treating patients with mCRPC with radium-223 in routine clinical practice. The aim is to provide an overview of the current use of radium-223 in the treatment of patients with mCRPC, and to discuss best practices for patient selection and on-treatment monitoring. Where agreement was reached, guidance on the optimal use of radium-223 is provided.
二氯化镭-223（镭-223）于2013年在美国和欧洲被批准用于治疗去势抵抗性前列腺癌（CRPC）和有症状的骨转移患者。这是在一项有症状前列腺癌的α镭（ALSYMPCA）试验中，与安慰剂和最佳标准治疗（BSoC）相比，报告了接受镭-223和最佳标准治疗的患者有总体生存获益之后。当时，多西他赛是转移性CRPC（mCRPC）患者的标准一线选择。从那时起，治疗格局发生了巨大变化，新的激素药物（阿比特龙和恩杂鲁胺）被认为是许多患者的一线选择。在现代环境中，镭-223的最佳患者特征，以及其与其他获批药物序贯使用或联合使用的最佳方式尚不清楚，可用的明确指南很少。本文报告了一组在常规临床实践中用镭-223治疗mCRPC患者经验丰富的泌尿科医生和医学肿瘤学家的观点。目的是概述镭-223目前在mCRPC患者治疗中的应用，并讨论患者选择和治疗监测的最佳实践。在达成共识的地方，提供了镭-223最佳使用的指导。
