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UPJ INSIGHT Radium-223 Utilization Patterns and Outcomes in Clinical Practice
By: Lior Taich, MD; Hanson Zhao, MD; Shannon R. Stock, PhD; Lauren E. Howard, MS; Amanda M. De Hoedt, MS; Martha K. Terris, MD; Christopher L. Amling, MD; Christopher J. Kane, MD; Matthew R. Cooperberg, MD, MPH; William J. Aronson, MD; Zachary Klaassen, MD; Thomas J. Polascik, MD; Adriana C. Vidal, PhD; Stephen J. Freedland, MD | Posted on: 01 Sep 2022
Taich L, Zhao H, Stock SR, et al. Radium-223 utilization patterns and outcomes in clinical practice. Urol Pract. 2022;9(5)405-413.
Study Need and Importance
Radium-223 was approved by the U.S. Food and Drug Administration in 2013 for the treatment of metastatic castration-resistant prostate cancer on the basis of improved overall survival and delayed skeletal events in the seminal ALSYMPCA trial. Despite the observed benefits, the application and practice patterns of radium-223 outside of clinical trials are largely unknown. We describe the use of radium-223 in a large and multiracial population of men in the entire Veterans Affairs Healthcare System.
What We Found
We found that radium-223 is used as second- (35%) or third-line (48%) therapy as part of 5 common treatment patterns. Radium-223 was least frequently used as a first-line therapy agent, accounting for only 6% of patients. Our cohort had a shorter median overall survival (11 vs 14.9 months) than in ALSYMPCA. We found that men who received the treatment pattern of androgen receptor-
targeted agent-docetaxel-radium had worse overall survival, likely attributable to patient selection bias. Only 40% of patients in this series received a full 6 injections of radium.
Limitations
There is an inherent patient selection bias for each treatment due to the retrospective nature of the study, making it difficult to discern treatment effects vs natural course of disease. In addition, there may have been a degree of therapy overlap in the treatment sequences that was unaccounted for.
Interpretation for Patient Care
Our study provides insight regarding the incorporation of radium-223 into clinical practice within a multiethnic population across multiple providers in the United States within the Veterans Affairs system. In this real-world cohort, radium-223 appears to be used later in the disease course than in ALSYMPCA with concomitant shorter survival, higher number of skeletal-related events and lower treatment completion rates.