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dc.contributor.authorParker, C
dc.contributor.authorHeidenreich, A
dc.contributor.authorNilsson, S
dc.contributor.authorShore, N
dc.date.accessioned2018-02-13T09:23:30Z
dc.date.issued2018-04
dc.identifier.citationProstate cancer and prostatic diseases, 2018, 21 (1), pp. 37 - 47
dc.identifier.issn1365-7852
dc.identifier.urihttps://repository.icr.ac.uk/handle/internal/1047
dc.identifier.eissn1476-5608
dc.identifier.doi10.1038/s41391-017-0020-y
dc.description.abstractBACKGROUND:Treatment options for metastatic castration-resistant prostate cancer (mCRPC) have expanded in recent years and include cytotoxic agents (e.g., docetaxel and cabazitaxel), immunotherapy (e.g., sipuleucel-T), oral hormonal therapies targeting the androgen receptor axis (e.g., enzalutamide and abiraterone), and targeted alpha therapy (e.g., radium-223 dichloride (radium-223)). Although treatment guidelines have been updated to reflect the availability of new agents, it is not easy to apply them in daily clinical practice because recommendations vary depending on patient comorbidities and disease characteristics. Furthermore, therapeutic accessibility, clinical judgment, and experience affect the selection of treatment options. METHODS:In this review, we provide practical guidance for the integration of radium-223 into the management of patients with mCRPC based on our collective clinical experience, as well as the available clinical trial data. RESULTS:Radium-223 is a targeted alpha therapy; as a bone-seeking calcium mimetic, it accumulates in hydroxyapatite areas surrounding tumor lesions and selectively binds to the areas of increased bone turnover. Radium-223 prolongs overall survival and delays time to the first symptomatic skeletal events in men with mCRPC, and is indicated for the treatment of patients with CRPC, symptomatic bone metastases, and no known visceral metastases. We review its clinical efficacy and safety, practical guidance on identifying the appropriate patient, and recommendations for how best to educate and inform prospective patients regarding their treatment decision making. In addition, we review recent evidence for sequential and combination therapies with radium-223, provide our experiences with these treatment approaches, and discuss their implications for the future treatment of patients with mCRPC. CONCLUSIONS:Based on our clinical experience, radium-223 should be considered relatively early in the treatment course in patients with mCRPC with bone metastases. Coordination of care among multidisciplinary team members, patients, and caregivers is essential for optimizing safe and effective treatment with all CRPC therapies.
dc.formatPrint-Electronic
dc.format.extent37 - 47
dc.languageeng
dc.language.isoeng
dc.rights.urihttps://creativecommons.org/licenses/by/4.0
dc.subjectHumans
dc.subjectBone Neoplasms
dc.subjectRadium
dc.subjectTaxoids
dc.subjectPhenylthiohydantoin
dc.subjectAndrostenes
dc.subjectReceptors, Androgen
dc.subjectTreatment Outcome
dc.subjectMale
dc.subjectProstatic Neoplasms, Castration-Resistant
dc.subjectDocetaxel
dc.titleCurrent approaches to incorporation of radium-223 in clinical practice.
dc.typeJournal Article
dcterms.dateAccepted2017-09-16
rioxxterms.versionofrecord10.1038/s41391-017-0020-y
rioxxterms.licenseref.urihttps://creativecommons.org/licenses/by/4.0
rioxxterms.licenseref.startdate2018-04
rioxxterms.typeJournal Article/Review
dc.relation.isPartOfProstate cancer and prostatic diseases
pubs.issue1
pubs.notesNot known
pubs.organisational-group/ICR
pubs.organisational-group/ICR/Primary Group
pubs.organisational-group/ICR/Primary Group/Royal Marsden Clinical Units
pubs.organisational-group/ICR
pubs.organisational-group/ICR/Primary Group
pubs.organisational-group/ICR/Primary Group/Royal Marsden Clinical Units
pubs.publication-statusPublished
pubs.volume21
pubs.embargo.termsNot known
dc.contributor.icrauthorParker, Chris


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