The effect of osteoprotective therapy on ongoing radium-223 in patients with primarily bone metastasised prostate cancer

Ziel/Aim:

Radium-223 practiced in patients with primarily bone metastasised prostate cancer. On the other hand, oteoprotective therapy with bisphosphonates or denosumab is commonly used in patients with bone metastasis to prevent or slow down osteolysis. There are occasionally side effects and more rarely serious complications associated with long term use of osteoprotective therapy like osteonecrosis of the jaw, as well as with Radium-223 like decrease of blood cells. Our goal is to investigate the therapy effect und risk of a combined therapy of radium-223 and osteoprotective therapy.

Methodik/Methods:

In this retrospective analysis, we compared the findings in 47 patients who underwent the radium-223 therapy, of whom 24 received at the same time osteoprotective therapy. As comparison, we used percentual changes in Prostate specific antigen (PSA), alkaline phosphatase (AP), bone specific alkaline phosphatase (bAP), haemoglobin (Hb), leucocytes (leu), platelets count (pl), as well as changes in clinical wellbeing and scintigraphical results.

Ergebnisse/Results:

Across the different parameters correlating to certain cancer activities (PSA, AP, bAP) we found no significant differences between the two groups. There was also no significant difference in Hb, and pl between the groups. Interestingly, the group with combined radium-223 and osteoprotective therapy showed significant less decrease of leucocytes. There is also no significant difference in scintigraphical findings and clinical wellbeing.

Schlussfolgerungen/Conclusions:

Our result showed that osteoprotective therapy accompanying radium-223 therapy had no negative impact on the course of the prostate carcinoma. PSA, AP and bAP remained unaffected by the therapy combination. There was also no finding for negative impact on hematopoiesis by the combined therapy; to the contrary, we even observed a significant milder decrease of leucocytes in patients who received the both therapy combined. Thus we can assume that there is no increased risk for haematological toxicity or negative interference for the therapy effect of radium-223 by applying osteoprotective drugs during the radium-223 therapy.