Efficacy and safety analysis of radium-223 in patients with prostate cancer castration-resistant and bone metastasis
Análisis de eficacia y seguridad del radio-223 en pacientes con cáncer de próstata resistentes a la castración y metástasis óseas
Alfonso Quiñones, PA
Romero Prada, ME
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AbstractObjectives Radium-223 is a radiopharmaceutical with alpha waves emission. Recently, clinical discussion focus on using the combination of Radium-223 with abiraterone or enzalutamide, or previous chemotherapy. We aimed to evaluate the efficacy and safety of radium-223 in patients with prostate cancer castration-resistant and bone metastasis as an alternative choice of treatment. Methods We conducted a literature review at MEDLINE, Embase, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, LILACS, Cochrane Central Register of Controlled Trials, WHO International Clinical Trials Registry Platform, and ClinicalTrials.gov, which used the combination of terms related to the disease, intervention and comparators. We defined as outcomes the overall survival, progression free survival, tumor reduction, disease control ratio, adverse effects and quality of life. We included systematic reviews, meta-analysis and clinical trials, published before November 2017. Also, the quality of evidence was assessed by using quality-value international scales. Results of all included studies were described and no indirect comparison analysis was made. Results We identified 92 studies, 79 were excluded by title and abstract. Thirteen were selected for full text evaluation. Final analysis included two systematic reviews, one meta-analysis and five clinical trials. Trials compared radium-223 or its comparators with placebo. The meta-analysis showed that radiopharmaceutical reduces skeletal muscle events, and improves functionality and quality of life [OR 0.63 (95%CI 0.51-0.78; I2=27%, p=<0.0001)]. It also evidenced that radium-223 is less toxic and increased overall survival. A systematic review reported similar results to meta-analysis on quality of life. Other systematic review showed that radium-223 and bicalutamide improved overall survival, however the effect on progression free survival was not clear. Conclusions According with the available information, radium-223 is effective by increasing overall survival. Also, it’s safer than other radiopharmaceutical according to its pharmacological characteristics. Nevertheless, further studies are required to conduct head-to-head comparisons between radium-223 and other drugs.