Opinion|Videos|October 28, 2024
Radium-223 and Enzalutamide: Game-Changing PEACE III Phase 3 Data in mCRPC
Author(s)Pedro Barata, MD, MSc, FACP
Key Takeaways
- The PEACE III trial showed that BPAs reduced skeletal fracture risk from 33% to 3% in patients receiving radium-223.
- The radium-223 triplet regimen is considered superior to the enzalutamide doublet for metastatic castration-resistant prostate cancer.
Panelists discuss how the PEACE III trial findings demonstrate the superiority of combining radium-223 with enzalutamide in treating metastatic castration-resistant prostate cancer, highlighting improved efficacy, the critical importance of bone-protective agents in reducing fracture risk, and the potential for this triplet therapy to become the new standard of care over enzalutamide alone.
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Video Content above is prompted by the following:
- Discuss the findings from the PEACE III trial, which compared enzalutamide with enzalutamide plus radium-223 in patients with previously untreated castration-resistant prostate cancer that has metastasized to bone.
- Giving bone-protective agents (BPAs) to patients receiving radium-223 in PEACE III nearly eliminated risk for skeletal fracture (fracture incidence was 33% without BPAs and 3% with BPAs) (Tombal et al [2019])
- This is proving that enzalutamide doublet shouldn’t be used anymore. Radium-223 triplet on top of ARI doublet (in metastatic castration-resistant prostate cancer) is superior combination. Unless there’s a big safety signal, this study will now prove that radium-223 triplet beats enzalutamide doublet.
- In which patients would you consider using an enzalutamide–radium-223 combination? (Shariftabrizi et al [2023])
- What would be absolute or relative contraindications for radium-223 use?
- What bone support/monitoring strategies (eg, bone-protective agent use, bone density scans) are needed to improve safety of radium-223 in clinical practice? (Tombal et al [2019])
- What strategies would you recommend for increasing utilization for bone health in general for all metastatic patients?
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