Treatment of Bone Metastases in Metastatic Castration-Resistant Prostate Cancer with Symptomatic Multiple Skeletal Metastases
When bone metastases represent the dominant site of disease in metastatic castration-resistant prostate cancer (mCRPC) and the patient is symptomatic with multiple skeletal lesions, a specific, evidence-guided treatment sequence applies.
Clinical Scenario
Metastatic castration-resistant prostate cancer with symptomatic multiple skeletal metastases as the dominant site of disease. This bone-dominant pattern defines a patient population for whom a dedicated bone-targeting treatment strategy is indicated.
Treatment Approach (Partial Overview)
Management involves a bone-targeted agent given prior to initiation of a radiopharmaceutical approach. The radiopharmaceutical is administered intravenously on a fixed-cycle schedule as a single agent alongside hormonal backbone therapy. Certain combinations are explicitly not recommended — the complete sequencing, agent selection criteria, and schedule are detailed in the full protocol.
References
- 223Ra is a valuable treatment option for patients with mCRPC and symptomatic multiple skeletal metastases as the dominant site of disease.
- Currently, 223Ra should be given as a single agent [with luteinising hormone-releasing hormone (LHRH) analogues] following previous use and/or in combination with a BTA.
- A BTA should be started before 223Ra.
- In the ALSYMPCA trial, patients with symptomatic, bone-dominant disease who failed or were deemed unfit for docetaxel received 223Ra or placebo every 4 weeks in addition to best standard care.
- The use of this combination is not recommended and, based on these results and experience with combined enzalutamide and 223Ra, a BTA should be started before 223Ra.
DOI: 10.1016/j.annonc.2020.07.019
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