鐳-223用於治療去勢抗性攝護腺癌:單一醫學中心的真實世界經驗

曾浩翔、蔡禮賢、黃志平、張兆祥、吳錫金、林精湛¹、林哲弘¹、葉進仲、連啟舜、張議徽、楊啟瑞、蕭博任、謝博帆、陳冠亨、梁基安²

中國醫藥大學附設醫院 泌尿部

Radium-223 for mCRPC: Real-world experience of a single-center

Chen Hao Xiang, Li-Hsien Tsai, Chi-Ping Huang, Chao-Hsiang Chang, Hsi-Chin Wu , Ching-Chan Lin,
Che-Hung Lin, Chin-Chung Yeh, Chi-Shun Lien , Yi-Huei Chang, Chi-Rei Yang, Po-Jen Hsiao, Po-Fan Hsieh, Guan-Heng Chen, Ji-An Liang

Department of Urology, China Medical University Hospital
¹Deparment of Oncology, China Medical University Hospital, Taichung, Taiwan
²Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan

Purpose:

We performed a descriptive analysis of the real-world data on the impact of radium-223 on metastatic castration-resistant prostate cancer patients (mCRPC) in our center.

Materials and Methods:

We retrospectively evaluated all mCRPC patient who has received or currently receiving radium-223. The primary outcome of this study was the overall survival of the patients receiving radium-223. The secondary outcome including the median time to the first skeletal related event(SRE), the median time to increase in total alkaline-phosphatase(Alk-P), the median time to increase in prostate specific antigen(PSA), number of patient with >30% reduction of Alk-P, number of patient with abnormal Alk-P at baseline resulted in the normalization of Alk-P after receiving radium-223. We further performed a subgroup analysis of the high PSA group, rapid mCRPC, patient with previous second-line ADT.

Results:

12 of 29 patients received their final dose within 90 days at the time this retrospective study is conducted(2021/03/28).  29 mCRPC patients in China Medical University Hospital have received radium-223.  17/29(58.6%) of the patients had finished 6 courses of the treatment. Of the 12 patients who have not completed 6 courses, 6 expired, 3 discontinued due to progression of the disease, 1 discontinued because of intolerance of the adverse effect of the radium-223, and the remaining 2 patients are currently under treatment and  both of them have received 5 doses of radium-223.

The median age of the study population is 75 years old (range 62 to 89). 26/29 of the included patient had previous second-line ADT exposure(enzalutamide or darolutamide or abiraterone). The overall survival of the patients was 79.3% and the median time of survival was 221 days. 4/29(13.8%) of the patient had developed SRE. The median time to SRE is 237.5 days after the initiation of the first dose of radium-223. The number of patient with >30% reduction of Alk-P is 10/26(38.5%). The number of the patient with abnormal Alk-P at baseline resulted in the normalization of Alk-P after receiving radium-223 is 6/10(60%). As this is a retrospective study, the pain score of the patient was not available. Therefore, we analyze the baseline analgesic used by the patient. Of the 29 patients included in this study, 13/29(44.8%) have the usage of opioids at baseline.  Among these patients, 7/13 had de-escalation of the analgesic after the initiation of radium-223. The median dosage resulted in the de-escalation of analgesic was the second dose.

Conclusion:

Radium-223 provided favourable clinical response and overall survival in mCRPC patients.