Treatment outcomes with radium-223 in docetaxel-naïve versus docetaxel-treated metastatic castration-resistant prostate cancer patients: Real-world evidence from Taiwan

Ping Chia Chiang, Po Hui Chiang, I. Hsuan Alan Chen, Yen Ta Chen, Hung Jen Wang, Yuan Tso Cheng, Chih Hsiung Kang, Chien Hsu Chen, Yi Yang Liu, Yu Li Su, Yen Hao Chen, Hao Lun Luo*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

1 Scopus citations


While radium (Ra)-223 is among the multiple, known life-prolonging treatments in bone-predominant metastatic castration-resistant prostate cancer (mCRPC), optimal treatment sequencing has not been determined, particularly in the Asia-Pacific context. Hence, we aimed to compare treatment outcomes of docetaxel-naïve and post-docetaxel mCRPC patients undergoing Ra-223 therapy in Taiwan. Using a single-center retrospective cohort design, we reviewed records of adult patients receiving Ra-223 for bone-metastatic mCRPC from 2018 to 2021. Patients were categorized into docetaxel-naïve or post-docetaxel groups based on history of docetaxel use preceding Ra-223. We compared the 2 groups in terms of all-cause death, 6-cycle treatment completion, and the following secondary outcomes: pain control, change in biochemical parameters (prostate-specific antigen, lactate dehydrogenase, alkaline phosphatase), biochemical response, and treatment-emergent adverse events. We performed total population sampling and a complete case analysis. We included 48 patients (25 docetaxel-naïve, 23 post-docetaxel) in the study. The mean follow-up duration was 12.4 months for the entire cohort. The docetaxel-naïve group exhibited a significantly lower all-cause mortality rate versus the post-docetaxel group (40.0% vs 78.3%, P =.02), as well as a significantly higher treatment completion rate (72.0% vs 26.1%, P <.01). We did not find significant differences in pain control, change in biochemical parameters, biochemical response, or hematologic treatment-emergent adverse events between the 2 groups. However, the docetaxel-naïve group had a numerically higher pain control rate, numerically greater improvements in alkaline phosphatase and prostate-specific antigen, and numerically lower rates of grade ≥ 3 neutropenia and grade ≥ 3 thrombocytopenia than the post-docetaxel group. Use of Ra-223 in docetaxel-naïve patients with mCRPC led to lower mortality and higher treatment completion than post-docetaxel use. Our study adds preliminary real-world evidence that Ra-223 may be used safely and effectively in earlier lines of treatment for bone-predominant mCRPC. Further large-scale, longer-term, and controlled studies are recommended.

Original languageEnglish
Pages (from-to)E32671
JournalMedicine (Spain)
Issue number5
StatePublished - 03 02 2023

Bibliographical note

Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.


  • adverse effects
  • alkaline phosphatase
  • castration-resistant prostatic neoplasm
  • docetaxel
  • radium-223
  • Prostate-Specific Antigen
  • Prostatic Neoplasms, Castration-Resistant
  • Humans
  • Docetaxel
  • Male
  • Treatment Outcome
  • Alkaline Phosphatase
  • Pain
  • Taiwan
  • Retrospective Studies
  • Radium


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