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Hematologic Safety ...
Hematologic Safety of Radium-223 Dichloride : Baseline Prognostic Factors Associated With Myelosuppression in the ALSYMPCA Trial
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Vogelzang, Nicholas J. (author)
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Coleman, Robert E. (author)
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Michalski, Jeff M. (author)
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- Nilsson, Sten (author)
- Karolinska Institutet
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O'Sullivan, Joe M. (author)
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Parker, Christopher (author)
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- Widmark, Anders (author)
- Umeå universitet,Onkologi
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Thuresson, Marcus (author)
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Xu, Lei (author)
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Germino, Joseph (author)
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Sartori, Oliver (author)
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(creator_code:org_t)
- CIG MEDIA GROUP, LP, 2017
- 2017
- English.
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In: Clinical Genitourinary Cancer. - : CIG MEDIA GROUP, LP. - 1558-7673 .- 1938-0682. ; 15:1, s. 42-52
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Abstract
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- Radium-223 was minimally myelosuppressive. Multivariate analyses of data from ALSYMPCA patients identified baseline factors that may increase hematologic toxicity risk with radium-223. Extent of disease and degree of prostate-specific antigen elevation were predictive of grade 2-4 anemia; prior docetaxel, and decreased hemoglobin and platelets were predictive of grade 2-4 thrombocytopenia. Patients with these factors should be closely monitored during radium-223 therapy. Background: Myelosuppression is common in patients with progressive castration-resistant prostate cancer and bone metastases. Radium-223 prolongs overall survival in these patients but may cause myelosuppression; understanding risk factors will improve clinical decision making. We describe hematologic safety of radium-223 in ALSYMPCA and post hoc analyses identifying patients at increased risk for hematologic toxicity. Patients and Methods: Hematologic parameters and adverse events were analyzed. Multivariate analyses assessing baseline risk factors for hematologic toxicities were performed separately for radium-223 and placebo patients. Results: Nine hundred one patients received radium-223 (n = 600) or placebo (n = 301); 65% of radium-223 and 48% of placebo patients had the full 6 cycles. Grade 3/4 thrombocytopenia was more common in radium-223 versus placebo patients (6% vs. 2%). Logistic regression analyses identified significant baseline predictors for grade 2-4 hematologic toxicities related to radium-223 treatment: extent of disease (6-20 vs. < 6 bone metastases; odds ratio [OR] = 2.76; P = .022) and elevated prostate-specific antigen (OR = 1.65; P = .006) for anemia; prior docetaxel (OR = 2.16; P = .035), decreased hemoglobin (OR = 1.35; P = .008), and decreased platelets (OR = 1.44; P = .030) for thrombocytopenia. Neutropenia events were too few in placebo patients for a comparative analysis. There were no significant associations between hematologic toxicities and number of radium-223 injections received (4-6 vs. 1-3). Conclusion: Radium-223 has a favorable safety profile with a low myelosuppression incidence. Understanding baseline factors associated with myelosuppression may assist clinicians in avoiding severe myelosuppression events with radium-223.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Urologi och njurmedicin (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Urology and Nephrology (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Cancer och onkologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cancer and Oncology (hsv//eng)
Keyword
- Alpha-emitting radiopharmaceutical
- Anemia
- Castration-resistant prostate cancer
- Myelotoxicity
- Trombocytopenia
Publication and Content Type
- ref (subject category)
- art (subject category)
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- By the author/editor
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Vogelzang, Nicho ...
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Coleman, Robert ...
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Michalski, Jeff ...
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Nilsson, Sten
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O'Sullivan, Joe ...
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Parker, Christop ...
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show more...
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Widmark, Anders
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Thuresson, Marcu ...
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Xu, Lei
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Germino, Joseph
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Sartori, Oliver
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show less...
- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Urology and Neph ...
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Cancer and Oncol ...
- Articles in the publication
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Clinical Genitou ...
- By the university
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Umeå University
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Karolinska Institutet