Radium-223 systemic alpha-radiotherapy: targeted treatment of castration-resistant prostate cancer with bone metastases

In Russia, approaches to treatment of castration-resistant prostate cancer include chemotherapy (docetaxel, cabazitaxel), androgen signaling inhibitors (abiraterone, enzalutamide) and systemic alpha-radiotherapy (radium-223 dichloride). Radium-223 is a radioactive calcium mimetic which selectively accumulates in bone tissue affected by metastases. In the registration study it was shown that radium-223 significantly increases overall survival and time to first skeletal complication in castration-resistant prostate cancer patients with symptomatic metastases in bones and without visceral metastases. The review objective is to determine the profile of patients who can get the most prominent benefits from systemic radiotherapy, as well as to identify the optimal placement of radium-223 in the sequence of therapeutic agents used for prostate cancer treatment