Bone-Targeting Radiopharmaceuticals as Monotherapy or Combined With Chemotherapy in Patients With Castration-Resistant Prostate Cancer Metastatic to Bone

Clin Genitourin Cancer. 2019 Apr;17(2):e281-e292. doi: 10.1016/j.clgc.2018.11.014. Epub 2018 Nov 17.

Abstract

In patients with metastatic castration-resistant prostate cancer, bone is the most common site for metastases. Because of their osteoblastic character, these lesions are very suitable for treatment with bone-seeking radiopharmaceuticals (RPs). Nowadays, radium-223-chloride is the only RP with a proven benefit in overall survival, whereas the β-emitting RPs are used for pain palliation. In the past, many trials that investigated RPs alone, or in combination with chemotherapy have been performed. Because of different designs, characteristics of included patients, and chemotherapeutical and RP regimens, interpretation of the promising data and positioning of RPs in the treatment of metastatic prostate cancer has become difficult. In this review, we provide an overview of the existing data per RP with a focus on the different RPs in combination with chemotherapy. Furthermore, we aim to clarify the benefits on pain response and quality of life. Finally, we focus on the optimal timing and use of biomarkers in the treatment of patients with castration-resistant prostate cancer with RPs.

Keywords: Bone-metastases; Combination therapy; Metastatic disease; Palliative treatment; Radionuclide.

Publication types

  • Review

MeSH terms

  • Bone Neoplasms / drug therapy*
  • Bone Neoplasms / secondary*
  • Cancer Pain
  • Clinical Trials as Topic
  • Combined Modality Therapy
  • Drug Therapy
  • Humans
  • Male
  • Prostatic Neoplasms, Castration-Resistant / drug therapy*
  • Quality of Life
  • Radioisotopes / therapeutic use
  • Radiopharmaceuticals / therapeutic use*
  • Radium / therapeutic use*
  • Survival Analysis
  • Treatment Outcome

Substances

  • Radioisotopes
  • Radiopharmaceuticals
  • radium Ra 223 dichloride
  • Radium