PT - JOURNAL ARTICLE AU - Gayed, Isis AU - Canfield, Steven AU - Fanous, Mina AU - Wan, David AU - Joseph, Usha AU - Amato, Robert TI - Optimizing Patient Selection for Therapy with Radium 223 Dichloride DP - 2016 May 01 TA - Journal of Nuclear Medicine PG - 1560--1560 VI - 57 IP - supplement 2 4099 - http://jnm.snmjournals.org/content/57/supplement_2/1560.short 4100 - http://jnm.snmjournals.org/content/57/supplement_2/1560.full SO - J Nucl Med2016 May 01; 57 AB - 1560Objectives Radium-223 Dichloride (Xofigo) has been approved in the US for treatment of bony metastases from castrate refractory prostate cancer (CRPC).This study describes our experience in patients treated with Ra-223 Xofigo. It attempts to optimize patients’ selection for the best outcome from therapy with Ra-223 Xofigo.Methods All consecutive patients who were referred for treatment with Ra 223 Xofigo were prospectively followed up. Patients’ demographics, functional status per the Eastern Cooperative Oncology Group (ECOG) performance score, pain level per the numeric rating score (NRS), PSA, creatinine and hematological values were compared before each injection and at the end of therapy. Patients also had a bone scan (BS) prior to and at the end of therapy if they completed 5 or 6 injections. Patients were divided into favorable response (FR) group if their pain and/or functional status improved versus the unfavorable response (UR) group if they did not improve, deteriorated or deceased.Results Fifteen patients with average age 71.9 years were treated with Ra-223 Xofigo. The median interval between the BS and the first dose of treatment was 30.5 days. Nine patients had innumerable bone metastases, 3 patients had superscans and 3 patients had 2-5 bony lesions. One patient was lost to follow up after the first injection. There were 6 patients in the FR and 8 in the UR group. Four patients in the UR group had innumerable bone metastases, 2 had superscan, and 2 had 2-3 lesions. Five patients in FR group had innumerable matasases and one had superscan. Patients with UR had a mean ECOG and NRS pain scores of 1.4 and 5.1 versus 1.0 and 5.2 in the FR group. Mean PSA and creatinine levels in the UR group were 237.1 ng/mL and 1.3 mg/dL versus 22.9 ng/mL and 1.0 mg/dL in the FR group. The mean hemoglobin, platelets and absolute neutrophil values were 11.0 g/dL, 301.6 K/cmm, and 4.9 K/cmm in the UR group versus 11.7 g/dL, 197.8 K/cmm, and 4.4 K/cmm in the FR group. Five out of six patients with favorable response had a bone scan at the end of their therapy which showed improvement in 3 patients, mixed response in one patient and progression in another patient. Two patients in UR group completed 5 and 6 injections and had bone scans which in one patient showed significant increase in bony metastases and in the other showed flare of a clavicular lesion but otherwise stable metastases. Both patients who showed progression of bony metastases on BS, one in the FR and the other in the UR groups, had rising PSA levels over subsequent injections. Three patients in the UR group had worsening pain, deterioration of their functional status and rise of PSA levels in 2 of them after the first or second injections. Two of these patients had baseline superscans. Additionally, two patients in the UR group deceased after the first injection and one after the second injection, all with innumerable bony metastases.Conclusions CRPC patients with lower PSA, creatinine levels, higher hemoglobin level, and better functional status respond favorably to Ra-223 Xofigo therapy for their bony metastases. The number of bony lesions on baseline BS does not predict response to therapy, although superscan may be associated with UR.