Radionuclide Therapy for Osseous Metastases in Prostate Cancer

Bone metastases are associated with increased morbidity and poor prognosis in castration-resistant prostate cancer. Since 2010, 5 systemic therapies for metastatic castration-resistant prostate cancer have been approved by the US Food and Drug Administration based on an improvement in overall survival, offering alternatives to docetaxel, a chemotherapeutic agent with modest effect and significant toxicity. These systemic treatments belong to different classes of medication such as immunotherapy, hormonal therapy, chemotherapy, and radionuclide therapy. Radium-223 dichloride ((RaCl2)-Ra-223), approved in May 2013, is a novel aemitting radiopharmaceutical that targets areas of increased bone turnover in bone metastases, delivering densely ionizing radiation within a short tissue range and causing more severe chromosomal damage than beta-emitting radiopharmaceuticals. In this article, we review the clinical development of (RaCl2)-Ra-223, focusing on its effects on pain relief, skeletal events, biochemical markers, overall survival, quality of life, and safety. We also outline the differences between (RaCl2)-Ra-223 and the previously developed bone-seeking beta-emitters and briefly present new trials on the horizon involving (RaCl2)-Ra-223. (C) 2015 Elsevier Inc. All rights reserved.