Response to 223Ra-dichloride in castration-resistant prostate cancer with bone metastasis: A case report

Cabrera,Montserrat  Estorch; Rey,Pablo  Maroto; Carrió,Ignasi; Montes,Alberto; López,Diego  Alonso

doi:10.3892/ol.2016.4762

Response to 223Ra-dichloride in castration-resistant prostate cancer with bone metastasis: A case report

Authors:
- Montserrat Estorch Cabrera
- Pablo Maroto Rey
- Ignasi Carrió
- Alberto Montes
- Diego Alonso López
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Affiliations: Department of Nuclear Medicine, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, 08025 Barcelona, Spain, Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, 08025 Barcelona, Spain
Published online on: June 22, 2016 https://doi.org/10.3892/ol.2016.4762
Pages: 1323-1328
Copyright: © Cabrera et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Painful bone metastases are common in prostate cancer, with current treatments including non-steroidal analgesics and opiates, surgery, external beam radiotherapy and bone-targeting β-emitting radiopharmaceuticals. The α-emitting isotope 223Ra-dichloride (Ra-223) has been associated with improved overall survival and increased time to first skeletal‑related events in patients with castration‑resistant prostate cancer (CRPC) presenting with symptomatic bone metastases. The current study reports the case of a 70-year-old male patient, who was diagnosed with prostate cancer in 1999 upon presentation with increased prostate‑specific antigen (PSA) levels and painful bone metastases in the context of CRPC. In November 2010, subsequent to undergoing hormonal blockage, the patient was treated with ketoconazole (200 mg/8 h) followed by 10 cycles of docetaxel (75 mg/m2 every 3 weeks). Following disease progression, the patient received 6 doses of Ra‑223 (50 kBq/kg; 1 dose/4 weeks). During this treatment period, an improvement in the patient's symptoms, and levels of bone alkaline phosphatase (BAP) and PSA were noted. Furthermore, Ra‑223 was well‑tolerated without any relevant bone marrow toxicity. However, 2 months after the administration of the final dose of Ra‑223, PSA and BAP levels increased again, and bone pain deteriorated. A bone scan showed stable disease in the previously observed metastatic lesions; however, new lesions simultaneously appeared in different locations, indicating progressive disease.

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