Jack Andrews, Fellowship-Trained Urologic Oncologist and Surgeon-Scientist at the Mayo Clinic, shared on X:
“Prostate cancer paper of the day
PEACE-3 final OS (EORTC 1333, Gillessen et al.): enzalutamide with or without 6 cycles of radium-223 as first line therapy for mCRPC with bone mets (n=446).
- Median OS 38.2 vs 32.6 mo (HR 0.76, p=0.0096)
- rPFS still favors the combo (HR 0.71; primary analysis 19.4 vs 16.4 mo)
- Bone protecting agent (denosumab or zoledronic acid) became mandatory mid trial (from 2018). Ra-223 plus an ARPI should not be given without one.
- Grade ≥3 AEs higher with combo (69% vs 58%), hypertension most common
Takeaway: adding Ra-223 to enzalutamide improves OS and rPFS in bone predominant first line mCRPC, and a bone protecting agent is a must. Fracture risk and skeletal health are part of the regimen, not an add on.
In the era of intensified mHSPC treatment, Ra-223 can still be a nice option to consider for men with bone predominant disease. Sequencing versus Lu-PSMA and after doublet or triplet therapy still needs judgment.
For the man with progressive bone dominant mCRPC after intensified hormone sensitive therapy, when do you still pair early Ra-223 with an ARPI, and how do you make sure the bone protecting agent is on board?”
Title: Final overall survival results from EORTC 1333/PEACE-3 trial of enzalutamide plus radium-223 in metastatic castration-resistant prostate cancer
Authors: S. Gillessen, E. Gallardo, A. Choudhury, F. Saad, A. Soares, Y. Loriot, R. McDermott, A. Rodriguez-Vida, P. Isaacsson Velho, F. Nolè, F. Cruz, T. Roumeguere, G. Daugaard, R. Yamamura, E. Bompas, P. Maroto, F. Gomez Veiga, I. Skoneczna, K. Martins da Trindade, F. Mavignier Carcano, F. Lecouvet, C. Coens, C. Poncet, B. Fournier, B. Tombal
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