Pain efficacy with radium-223 (Ra-223) in patients (pts) with metastatic castration-resistant prostate cancer (mCRPC) in the PARABO observational study

Nuklearmedizin - NuclearMedicine, vol. 61, pp. 179

Abstract

Ziel/Aim Ra-223 is a bone targeted alpha emitter which showed a significant survival advantage and favorable safety profile in a phase 3 trial. Ra-223 also delayed opioid use and external beam radiotherapy in post hoc analyses of that trial. PARABO (NCT02398526) is a prospective, observational, noninterventional, single-arm study evaluating pain efficacy in mCRPC pts treated with Ra-223 in German real-life nuclear medicine settings. Methodik/Methods We assessed pain response, defined as a≥2 point improvement in Brief Pain Inventory short form (BPI-SF) worst pain score in pts with baseline (BL) worst pain>1, in the overall population and by extent of disease (EOD;≤20 vs>20 lesions), opioid use, and Ra-223 cycles received (5–6 vs≤4). Ergebnisse/Results 354 pts started Ra-223 between Mar 2015 and Dec 2017. At BL, 260 pts (73%) had Eastern Cooperative Oncology Group performance status 0/1; 37 (10%) had<6 metastatic lesions, 124 (35%) had 6–20 lesions, 127 (36%) had>20 lesions, and 55 (15%) had a superscan; 242 pts (68%) had received prior systemic life-prolonging therapy (median 2). In total, 169 pts (48%) used opioids at any time (116 used opioids before/at BL, 53 started opioids during Ra-223 therapy). Pts received a median of 6 Ra-223 injections (range 1–6); 236 (67%) had 5–6 injections, and 118 (33%) had≤4 injections. Of 216 pts with BL worst pain>1, 128 (59%) had a clinically meaningful pain response; the rate was 60% in pts with≤20 lesions vs 59% in pts with>20 lesions; 65% in pts with opioid use vs 54% in pts without opioid use; and 67% in pts with 5–6 Ra-223 injections vs 43% in pts with≤4 injections. Mean BPI-SF component scores during Ra-223 treatment improved or were maintained from baseline, regardless of EOD or opioid use. Schlussfolgerungen/Conclusions In this real-life study, pts with mCRPC experienced reduction of bone-associated pain during Ra-223 therapy, regardless of EOD or opioid use. The benefit appeared most pronounced in pts who received 5–6 cycles of Ra-223. Publication History Article published online: 14 April 2022 © 2022. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

Authors 9

1. HOLGER PALMEDO
   Affiliation as printed

   ÜBAG Radiologie und Nuklearmedizin Kaiserpassage, Abteilung für Nuklearmedizin, Bonn

2. Susanne Martina Eschmann

   Marienhospital Stuttgart

   Affiliation as printed

   Marienhospital Stuttgart, Abteilung für Nuklearmedizin, Stuttgart

3. F. Straube

   Diabetes-Zentrum Quakenbrück

   Affiliation as printed

   Harzer PET-Zentrum & Nuklearmedizin, Goslar

4. Andreas Niesen

   Diakovere

   Affiliation as printed

   Diakovere Henriettenstift, Abteilung für Nuklearmedizin, Hannover

5. Vahé Barsegian

   Helios Hospital Schwerin

   Affiliation as printed

   Helios Kliniken Schwerin, Abteilung für Nuklearmedizin, Schwerin

6. Knut Liepe
   Affiliation as printed

   Klinikum Frankfurt Oder, Abteilung für Nuklearmedizin, Frankfurt

7. Felix Manuel Mottaghy Aachen Department of Nuclear Medicine

   RWTH Aachen University · Universitätsklinikum Aachen

   Affiliation as printed

   University Hospital RWTH Aachen University, Department of Nuclear Medicine, Aachen

8. J. Pinkert

   Bayer (Germany)

   Affiliation as printed

   Bayer AG, Berlin

9. Ken Herrmann

   Essen University Hospital

   Affiliation as printed

   Universitätsklinikum Essen, Abteilung für Nuklearmedizin, Essen