Ongoing Trials Suggest Benefits of Radium-223 Combos in Prostate Cancer


Early data from ongoing clinical trials suggest the potential safety and efficacy of novel radium-223 combinations as treatment for metastatic castration-resistant prostate cancer.

Future research will look to affirm the overall survival (OS) and safety benefits of radium-223 in combination with agents including docetaxel in metastatic castration-resistant prostate cancer (mCRPC) studies such as the phase 3 DORA trial (NCT03574571), according to Scott T. Tagawa, MD, MS, FACP.

Tagawa, a professor of medicine and urology and medical director of the Genitourinary Oncology Research Program at Weill Cornell Medicine, spoke with CancerNetwork® at the 16th Annual Interdisciplinary Prostate Cancer Congress® and Other Genitourinary Malignancies regarding ongoing clinical trials investigating the efficacy of different radium-223 combination therapies in mCRPC.


There are a couple of ongoing phase 3 trials. One is a trial called PEACE III [NCT02194842], which is taking a patient population [with] untreated mCRPC—meaning frontline—with the backbone enzalutamide [Xtandi] with or without radium-223. This trial started with the benefit early on of knowing the phase 3 ERA 223 trial [NCT02043678] results. Early on, they mandated the use of bone health agents. We’ve seen a couple of initial safety presentations at [the American Society of Clinical Oncology Annual Meeting] that demonstrate that there’s no excess fractures to date, although we’re waiting for the overall efficacy results of that study.1

And then a separate combination study, based upon a PCC TC randomized phase 2 study [NCT01106352] led by [Michael J. Morris, MD], [is evaluating] docetaxel and radium-223. Again, [it] makes sense targeting different compartments and also [with the] radiosensitizing properties of the taxane. That randomized phase 2 trial showed improvements in efficacy with lower toxicity to the combination.2 Now, the combination is an adjusted dose and schedule, so docetaxel at 60 mg/m2 and radium-223 every 6 weeks to match with the docetaxel. In any case, that has led to the phase 3 DORA trial, which is ongoing [with] accrual, with probably more than a third still left to go. But what we’re hoping to see is an [OS] benefit, maybe with an improved safety profile.


  1. Tombal BF, Loriot Y, Saad F, et al. Decreased fracture rate by mandating bone-protecting agents in the EORTC 1333/PEACE III trial comparing enzalutamide and Ra223 versus enzalutamide alone: An interim safety analysis. J Clin Oncol. 2019;37:5007. doi:10.1200/JCO.2019.37.15_suppl.5007
  2. Morris MJ, Loriot Y, Sweeney CJ, et al. Radium-223 in combination with docetaxel in patients with castration-resistant prostate cancer and bone metastases: a phase 1 dose escalation/randomised phase 2a trial. Eur J Cancer. 2019;114:107-116. doi:10.1016/j.ejca.2019.04.007
Related Videos
Collaboration among nurses, social workers, and others may help in safely administering outpatient bispecific T-cell engager therapy to patients.
Immunotherapy may be an “elegant” method of managing colorectal cancer, says Gregory Charak, MD.
D. Ross Camidge, MD, PhD, spoke about how the approval of alectinib is the beginning of multiple other approvals for patients with ALK-positive NSCLC.
Nurses should be educated on cranial nerve impairment that may affect those with multiple myeloma who receive cilta-cel, says Leslie Bennett, MSN, RN.
Treatment with cilta-cel may give patients with multiple myeloma “more time,” according to Ishmael Applewhite, BSN, RN-BC, OCN.
Nurses may need to help patients with multiple myeloma adjust to walking differently in the event of peripheral neuropathy following cilta-cel.
Administering neoadjuvant therapy to patients with colorectal cancer may help surgical oncologists attain a negative-margin resection.
Increasing screening for younger individuals who are at risk of colorectal cancer may help mitigate the rising early incidence of this disease.
Laparoscopy may reduce the degree of pain or length of hospital stay compared with open surgery for patients with colorectal cancer.
The use of proton therapy may offer a more specific depth charge compared with conventional radiation, according to Timothy Chen, MD.