Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA.
Department of Radiation Oncology, New Mexico Cancer Center, Albuquerque, NM, USA.
Curr Probl Cancer. 2019 Jun;43(3):205-212. doi: 10.1016/j.currproblcancer.2018.05.007. Epub 2018 May 31.
Radium-223 (Xofigo) is the first therapy with bone tropism for metastatic castrate-resistant prostate cancer (mCRPC) that has been shown to improve overall survival (OS). Although radium-223 has a positive effect on OS in men with mCRPC, there has been a paucity of reports from community practitioners, especially with regard to concurrent abiraterone and enzalutamide therapy. Significant differences in patient characteristics encountered may exist.
We conducted a retrospective study of men with mCRPC who received at least 1 cycle of radium-223 (n = 35). Baseline pain and ECOG PS as well as concurrent usage of abiraterone or enzalutamide were recorded. Side effect profiles for each patient throughout treatment were noted.
Baseline cohort characteristics include a median age of 75 years. 37% had an ECOG PS ≥ 2 and 23% reported severe pain at baseline. 31% received concomitant enzalutamide 31% concomitant abiraterone. Patients treated concurrently with either abiraterone or enzalutamide did not display additional toxicity. Median cohort OS was 10 months. Patients with no or mild pain had longer median OS than those with moderate or severe pain, 14 versus 7 months (P = 0.028). Patients with ECOG PS < 2 had longer median OS than those with ECOG PS ≥ 2, 13 versus 10 months (P = 0.0233).
This study highlights key differences in patient characteristics encountered by community practitioners. In this population, which presented with clinically advanced disease, there was an improved survival benefit for those treated earlier in their disease. Radium-223 was well tolerated and concurrent treatment with abiraterone or enzalutamide did not add additional toxicity. These 2 points seem to advocate for aggressive and early treatment of patients with radium-223 in the community.
镭-223（Xofigo）是首个具有骨靶向性的转移性去势抵抗性前列腺癌（mCRPC）治疗药物，已被证明可改善总生存期（OS）。尽管镭-223对 mCRPC 男性的 OS 有积极影响，但社区医生的报告很少，特别是关于同时使用阿比特龙和恩扎鲁胺治疗的报告。可能存在患者特征方面的显著差异。
我们对至少接受过 1 个周期镭-223 治疗的 mCRPC 男性患者进行了回顾性研究（n=35）。记录了基线时的疼痛和 ECOG PS 以及同时使用阿比特龙或恩扎鲁胺的情况。记录了每位患者整个治疗过程中的副作用情况。
基线队列特征包括中位年龄为 75 岁。37%的患者 ECOG PS≥2，23%的患者基线时报告严重疼痛。31%的患者同时接受恩扎鲁胺治疗，31%的患者同时接受阿比特龙治疗。同时接受阿比特龙或恩扎鲁胺治疗的患者未显示额外的毒性。中位队列 OS 为 10 个月。无或轻度疼痛的患者中位 OS 长于中度或重度疼痛的患者，分别为 14 个月和 7 个月（P=0.028）。ECOG PS<2 的患者中位 OS 长于 ECOG PS≥2 的患者，分别为 13 个月和 10 个月（P=0.0233）。
本研究强调了社区医生所遇到的患者特征的关键差异。在这群表现出临床晚期疾病的患者中，早期治疗的患者生存获益更大。镭-223 耐受性良好，同时使用阿比特龙或恩扎鲁胺不会增加额外的毒性。这两点似乎主张在社区中积极及早地使用镭-223 治疗患者。
