Dandapani Explores Radium-223 Combination in Metastatic Prostate Cancer

Savita Dandapani, MD, PhD, radiation oncologist at City of Hope, discusses the rationale behind a study evaluating the combination of radium-223, hormone therapy, and stereotactic body radiation therapy (SBRT) for the treatment of patients with metastatic castration-sensitive prostate cancer.

Transcription:

0:10 | Originally, I thought of it in 2016 to 2017, so pretty early on, and a few years after radium-223, the radiopharmaceutical that was FDA approved from the large ALSYMPCA trial. That was for metastatic castration-resistant prostate cancer. At the same time, there were a lot of trials being conducted for metastatic castration-sensitive prostate cancer or hormone-sensitive much earlier, when [patients] first get metastases. There are a lot of SBRT trials or [stereotactic ablative radiotherapy (SABR)] trials in that space.

1:00 | Here at City of Hope, we have a unique radiation research platform where we do a lot of radiopharmaceutical research. Once this became approved, I thought, why not combine this as treating micrometastatic disease because the [patients] have had metastatic disease, they progressed from there aggressive prostate cancer that was localized to metastases, and primarily bone metastases, and radium-223 treats the bone metastases. I thought, let's combine a short course of hormones, which was the backbone of the medical oncologist's treatment for metastatic prostate cancer at the time, and also add in SBRT to all the lesions we see on the current imaging standards, and add in radium-223.

1:50 | [Patients] appreciated this trial because it was a short course of hormones, and they do not like the [adverse] effects of hormones. The SBRT is well tolerated, as seen in multiple studies, and even in our study. Then, adding the radium-223 was the exploratory question. We were not sure how they were going to do that so early in their course, because in the ALSYMPCA trial, [patients] were getting it later in their course of treatment. Their ECOG status, things like that, were much different. These are very fit [patients] that I gave this course to. It was an aggressive treatment with the radiation combination of external radiation and radiopharmaceuticals. Then after that, stopping all treatment, and then just watching the [patients]. They liked that, because they wanted to see if we could treat all this, finish the treatment, and then just follow up with [prostate-specific antigen (PSA)] and imaging.

REFERENCE:

Dandapani S. Phase 2 trial of stereotactic body radiation therapy, hormone/androgen deprivation therapy and radium 223 dichloride for oligometastatic castrate sensitive prostate cancer (SHARP). Presented at: 2024 American Society for Therapeutic Radiology and Oncology Annual Meeting; September 29-October 2, 2024; Washington, DC. 1003.