Sartor, OHeinrich, DMariados, NMendez Vidal, M JKeizman, DThellenberg Karlsson, CPeer, AProcopio, GFrank, S JPulkkanen, KRosenbaum, ESeveri, STrigo Perez, J MWagner, VLi, RNordquist, L T2023-01-252023-01-252017Sartor O, Heinrich D, Mariados N, Méndez Vidal MJ, Keizman D, Thellenberg Karlsson C, et al. Re-treatment with radium-223: first experience from an international, open-label, phase I/II study in patients with castration-resistant prostate cancer and bone metastases. Ann Oncol. 2017 Oct 1;28(10):2464-2471http://hdl.handle.net/10668/11628Six radium-223 injections at 4-week intervals is indicated for patients with castration-resistant prostate cancer and symptomatic bone metastases. However, patients usually develop disease progression after initial treatment. This prospective phase I/II study assessed re-treatment safety and efficacy of up to six additional radium-223 injections. Patients had castration-resistant prostate cancer and bone metastases and six initial radium-223 injections with no on-treatment bone progression; all had subsequent radiologic or clinical progression. Concomitant agents were allowed at investigator discretion, excluding chemotherapy and initiation of new abiraterone or enzalutamide. The primary endpoint was safety; additional exploratory endpoints included time to radiographic bone progression, time to total alkaline phosphatase and prostate-specific antigen progression, radiographic progression-free survival, overall survival, time to first symptomatic skeletal event (SSE), SSE-free survival, and time to pain progression. Among 44 patients, 29 (66%) received all six re-treatment injections. Median time from end of initial radium-223 treatment was 6 months. Forty-one (93%) reported ≥1 treatment-emergent adverse event. No grade 4-5 hematologic treatment-emergent adverse events occurred. Only one (2%) patient had radiographic bone progression; eight (18%) had radiographic soft tissue tumor progression (three lymph node and five visceral metastases). Median times to total alkaline phosphatase and prostate-specific antigen progression were not reached and 2.2 months, respectively. Median radiographic progression-free survival was 9.9 months (12.8-month maximum follow-up). Five (11%) patients died and eight (18%) experienced first SSEs. Median overall survival, time to first SSE, and SSE-free survival were not reached. Five (14%) of 36 evaluable patients (baseline worst pain score ≤7) had pain progression. After 2 years of follow-up, 28 (64%) patients died, and the median overall survival was 24.4 months. Re-treatment with a second course of six radium-223 injections after disease progression is well tolerated, with minimal hematologic toxicity and low radiographic bone progression rates in this small study with limited follow-up. Favorable safety and early effects on disease progression indicate that radium-223 re-treatment is feasible and warrants further evaluation in larger prospective trials.enAttribution-NonCommercial 4.0 Internationalhttp://creativecommons.org/licenses/by-nc/4.0/Bone metastasesInjectionsProstateRadium-223Re-treatmentSafetyAgedAged, 80 and overAlkaline phosphataseBone neoplasmsHumansKallikreinsMaleMiddle agedProspective studiesProstate-specific antigenProstatic neoplasms, castration-resistantRadiumRe-irradiationresearch article28961839open accessAntígeno prostático específicoCalicreínasFosfatasa alcalinaNeoplasias de la próstata resistentes a la castraciónNeoplasias óseasRadioReirradiación10.1093/annonc/mdx3311569-8041PMC5834059https://doi.org/10.1093/annonc/mdx331https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5834059/pdf