A population-based study of the use of radium 223 in metastatic castration-resistant prostate cancer: Factors associated with treatment completion

Sunil Parimi, Erica Tsang, Abraham Alexander, Michael McKenzie, Francois Bachand, Katherine Sunderland, Kim N. Chi, Maria Aparicio, Daniel Worsley, Scott Tyldesley


Introduction: Radium 223 (Ra223) given for six cycles has proven efficacy in clinical trials, but its population-level generalizability has not been well-described. The objectives of this study were to describe population-based Ra223 use in the abiraterone and enzalutamide era and identify factors associated with completion.

Methods: All Ra223 patients at the British Columbia Cancer Agency between September 2013 and February 2016 were identified. Patients who completed <5 vs. ≥5 cycles were compared on patient characteristics, lines of prior therapy, prostate-specific antigen (PSA) and alkaline phosphatase (ALP) decline >30% from baseline (R30%), and survival, to identify factors associated with therapy completion.

Results: Ninety-one patients were identified; 48 (52.7%) completed ≥5 cycles. Median overall survival (mOS) was 10.7 months, PSA and ALP R30% were 21% and 52%, respectively. Completion of <5 cycles was associated with higher baseline ALP (p=0.05) and lower baseline hemoglobin (Hb) levels (p=0.03). Patients in the ≥5 cycles group had longer mOS than those in the <5 cycles group (16.2 vs. 5.9 months; p<0.0001), as well as higher PSA R30% (33.3% vs. 7.0%; p=0.002) and ALP R30% (66.7% vs. 34.9%; p=0.03). Patients with ALP ≥220 and Hb ≤118 had 3.85 times the odds of not completing ≥5 cycles vs. ALP <220 and Hb >118.

Conclusions: Compared to clinical trials, patients in a populationbased setting had more lines of therapy and shorter survival. Lower ALP and higher hemoglobin were associated with completion of ≥5 cycles, longer mOS, and greater incidence of PSA and ALP response.

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DOI: http://dx.doi.org/10.5489/cuaj.4415