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

Michael J. Morris, Yohann Loriot, Christopher J. Sweeney, Karim Fizazi, Charles J. Ryan, Daniel H. Shevrin, Emmanuel S. Antonarakis, Neeta Pandit-Taskar, Désirée Deandreis, Heather A. Jacene, Hubert Vesselle, Oana Petrenciuc, Cindy Lu, Jorge A. Carrasquillo, Celestia S. Higano

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: Radium 223 dichloride (radium-223)is an alpha particle–emitting bone-directed therapy that prolongs overall survival in men with bone-predominant metastatic castration-resistant prostate cancer (mCRPC). Docetaxel is an antimicrotubule cytotoxic agent that improves survival in mCRPC. We investigated whether combining these potentially cross-sensitising agents to dually target tumour and bone would be safe and effective. Patients and methods: Phase 1 was a dose escalation study to define a recommended phase 2 dose (RP2D)of docetaxel and radium-223. In phase 2a, patients were randomised 2:1 to the recommended combination regimen or docetaxel at a dose of 75 mg/m2 every 3 weeks (q3w). Patients with bone-predominant mCRPC were eligible. End-points were safety, efficacy and treatment-related changes in serum and imaging biomarkers. Results: Twenty patients were enrolled in phase 1; 53 patients were randomised in phase 2a: 36 to combination treatment and 17 to docetaxel alone. The RP2D for the combination was radium-223 55 kBq/kg every six weeks × 5 doses, plus docetaxel 60 mg/m2 q3w × 10 doses. Febrile neutropenia was dose limiting. A higher rate of febrile neutropenia was seen in the docetaxel monotherapy arm (15% vs 0%); the safety profile of the treatment groups was otherwise similar. The combination arm had more durable suppression of prostate-specific antigen (median time to progression, 6.6 vs 4.8 months, respectively), alkaline phosphatase (9 vs 7 months)and osteoblastic bone deposition markers. Conclusions: Radium-223 in combination with docetaxel at the RP2D was well tolerated. Exploratory efficacy data suggested enhanced antitumour activity for the combination relative to docetaxel alone. Comparative studies with end-points of clinical benefit are warranted. ClinicalTrials.gov number: NCT01106352.

Original languageEnglish (US)
Pages (from-to)107-116
Number of pages10
JournalEuropean Journal of Cancer
Volume114
DOIs
StatePublished - Jun 2019

Keywords

  • Castration-resistant prostate cancer
  • Combination treatment
  • Docetaxel
  • Radium 223 dichloride

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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