Researchers are now beginning to understand which men with castration-resistant prostate cancer (CRPC) might be helped by radium-223 (Xofigo), and for which men Xofigo will be a waste of time and money, and possibly cause harm.

They have found that baseline ECOG performance status, alkaline phosphatase (ALP), hemoglobin (Hb) levels, and the concomitant use of abiraterone acetate (Zytiga) or denosumab were indicators for improved overall survival (OS) when radium-223 is used. These findings came from a phase IIIb follow-up to the pivotal phase III ALSYMPCA trial presented at the 7th European Multidisciplinary Meeting on Urological Cancers (EMUC).

Data from the post-hoc analysis showed an improved overall survival in men treated with radium-223 and concomitant denosumab or abiraterone. The data was presented by Joan Carles, MD, Val d’Hebron Hospital, Barcelona, Spain, an investigator on the phase IIIb study.

· Parker C, Nilsson S, Heinrich D, et al. Alpha emitter radium-223 and survival in metastatic prostate cancer. N Engl J Med. 2013;369(3):213-223.

  • Saad F, Carles J, Gillessen S, et al. Radium-223 in an international early access program (EAP): effects of concomitant medication on overall survival in metastatic castration-resistant prostate cancer (mCRCP) patients. J Clin Oncol 33, 2015 (suppl; abstr 5034). –