Radium-223 and metastatic castration-resistant prostate cancer: All that glitters is not gold |
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Authors: | Carlo Aprile Marco G Persico Lorenzo Lodola Federica E Buroni |
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Institution: | Carlo Aprile, Marco G Persico, Lorenzo Lodola, Federica E Buroni, Nuclear Medicine Unit, Department of Oncohaematology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, ItalyMarco G Persico, Scuola Universitaria Superiore IUSS Pavia, 27100 Pavia, Italy |
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Abstract: | After being approved by the National Drug Agency in several countries, Radium-223 (Ra-223) is gaining wide acceptance in the treatment of bone metastatic castration resistant prostate cancer. The exact mechanism of action remain unclear: The established model of direct alpha-particle irradiation from the remodelling bone surface, where Ra-223 accumulates, surrounding the tumor foci can explain a lethal effect only on metastatic microdeposits, but not on higher tumor burden. According to the “pre-metastatic niche model”, it is likely that Ra-223 targets several non-tumoral cell types of the tumor microenvironment involved in the complex mechanism of cancer bone homing and colonization. A deeper insight into this hypothetical mechanism will lead to a more accurate dosimetric approach and to find optimal sequencing and/or combination with the other therapeutic options. |
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Keywords: | Radium-223 Bone metastases Castration resistant prostate cancer Tumor microenvironment Pre-metastatic niche model |
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