Fracture risk and survival outcomes in metastatic castration-resistant prostate cancer patients sequentially treated with abiraterone acetate and RADIUM-223

O. Caffo, V. Frantellizzi, M. Tucci, L. Galli, F. Monari, S. Baldari, C. Masini, R. Bortolus, G. Facchini, P. Alongi, S. Agostini, C. Zichi, E. Biasco, S. Fanti, S. Pignata, A. Filice, E. Borsatti, S. Rossetti, M. Spada, E. CortesiG. De Vincentis

Research output: Contribution to journalArticlepeer-review


Purpose: To evaluate the fracture risk and survival outcomes in patients with metastatic castration-resistant prostate cancer (mCRPC) who received sequentially abiraterone acetate (AA) and radium 223 [223Ra]RaCl2 in the daily clinical practice. Materials: We retrospectively reviewed the records of mCRPC patients who received [223Ra]RaCl2 immediately after progressing during an AA treatment line in everyday clinical practice. Results: We reviewed data of a consecutive series of 94 mCRPC patients. Most of the patients (85.1%) received [223Ra]RaCl2 as second- or third-line treatment. [223Ra]RaCl2 treatment was well-tolerated; there were only four cases of grade 3 anaemia, two cases of grade 3 leukopenia and one case of grade 3 neutropenia. The overall fracture rate is 2.1%; one fracture was recorded during the course of [223Ra]RaCl2 treatment, and one was recorded 1 month after its end. The fractures both occurred at metastatic sites. Median OS from [223Ra]RaCl2 start was more than 14 months regardless of the treatment line when [223Ra]RaCl2 was administered. Conclusion: The findings of this study show that the treatment with [223Ra]RaCl2 immediately after AA was active and safe with a very low risk of a fracture. Thus, the present observational report makes a valuable contribution to the current debate concerning the risks and benefits of including [223Ra]RaCl2 in the therapeutic algorithm. © 2020, Springer-Verlag GmbH Germany, part of Springer Nature.
Original languageEnglish
Pages (from-to)2633-2638
Number of pages6
JournalEur. J. Nucl. Med. Mol. Imaging
Issue number11
Publication statusPublished - 2020


  • Abiraterone
  • Fracturative risk
  • Radium 223
  • Safety
  • Sequencing
  • abiraterone acetate
  • alkaline phosphatase
  • prednisone
  • prostate specific antigen
  • radium chloride ra 223
  • zoledronic acid
  • adult
  • aged
  • anemia
  • Article
  • cancer survival
  • castration resistant prostate cancer
  • clinical assessment
  • clinical evaluation
  • clinical practice
  • constipation
  • diarrhea
  • disease course
  • drug tolerability
  • fatigue
  • fracture
  • human
  • leukopenia
  • major clinical study
  • male
  • medical record
  • metastatic castration resistant prostate cancer
  • multiple cycle treatment
  • nausea
  • neutropenia
  • observational study
  • outcome assessment
  • retrospective study
  • risk assessment
  • risk factor
  • survival rate
  • thrombocytopenia
  • treatment indication


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