1. Can radium-223 improve quality of life for men with CRPC?
Nillson and colleagues analysed health-related quality of life (QOL) data from the phase III multi-centre ALSYMPCA trial to determine the effects of radium-223 on patient experience of QOL. The ALSYMPCA trial was a randomised, double-blind, placebo-controlled trial which looked at radium-223 dichloride (radium-223) plus standard of care (SOC) compared to a placebo plus SOC for men with castration-resistant prostate cancer (CRPC). The trial demonstrated radium-223 versus placebo prolonged overall survival (OS) by 3.6 months and prolonged time to first symptomatic skeletal event (SSE) by 5.8 months. Radium-223 specifically targets prostate cancers that have spread to the bone. While radium-223 after chemotherapy is available on the NHS in England, NICE are currently considering whether it should also be available pre chemotherapy. In Scotland men with advanced prostate cancer can access the drug whether or not they have had chemotherapy.
For this study, the authors analysed data from two validated QOL questionnaires, the general EuroQoL 5D (EQ-5D) and the prostate-specific Functional Assessment of Cancer-Prostate (FACT-P). The questionnaires were completed by patients at randomisation (0), whilst on treatment at weeks 16 and 24, and at study discontinuation. The authors assessed the data for percentage of patients experiencing improvement, experiencing worsening and mean QOL scores during the study.
Results of the analysis demonstrated in patients receiving radium-223 a significantly higher percentage experienced meaningful improvement in QOL and a lower percentage experienced of pa meaningful worsening in QOL compared to patients who received placebo. Radium-223 treatment appeared to result in higher mean QOL scores on study versus placebo, and appeared to extend across multiple QOL domains. In conclusion, the authors stated their analysis of EQ-5D and FACT-P data from the ALSYMPCA trial demonstrated clinically meaningful QOL benefits, which accompanies improved survival results from analysis of earlier ALSYMPCA trial analysis.