Radium 223 combined with new hormone therapies for the treatment of castrate-resistant metastatic prostate cancer: scientific evidence and sharing of our experience

Presentation of the interesting case of a patient suffering from castrate-resistant prostate cancer (CRPC) with bone metastasis, who received concomitant treatment with abiraterone acetate (AA) and radium-223. The patient experienced significant clinical improvement in his quality of life and pain relief after beginning the aforementioned treatment, without being affected by adverse toxicities. Currently, the correct selection of patients to receive radium-223 treatment is still a clinical challenge in the case of CRPC with metastasis. In this article, we discuss the future prospects of this treatment, reviewing current evidence about concomitant therapies with radium-223 and its present state, based upon the recent recommendations from the Pharmacovigilance Risk Assessment Committee (PRAC), and the data presented in the ERA-223 study. Based on our clinical experience, we provide practical orientation for the integration of this radiopharmaceutical in the therapeutic plan for this group of patients. We conclude, despite some of the positive results and our excellent experience, that it would be wise to wait for the results of the clinical trials that are studying the safety and benefits of the combined use of radium-223 with new hormone therapies. Bearing in mind that to date, the only published large-scale randomised trial that investigated the combination of AR-axis-targeted therapy with Ra-223 is negative, the harms of the combination outweighed any benefits in ERA-223. Nonetheless, in order to recommend whether or not this treatment should be used, it is essential to define the patient profile that could benefit from this therapeutic option.