Dr. Vogelzang Reviews Radium-223 in Metastatic Prostate Cancer
Half of the the patients in expanded trial access Radium-223 are refusing chemotherapy treatment according to Dr. Vogelzang. He goes on to state that OS is roughly equivalent in patients who refuse chemotherapy, and those who have taken chemotherapy.
ALSYMPCA trial---47% of patients had not received prior treatment with docetaxel.
Dr. Vogelzang is largest user of Radium-223 in the country, and due to manufacturing supply issues, he is treating 2 patients a month.
Alpharadin's efficacy through its bone targeting mechanism is one of the biggest reasons I think Cabo will have better OS due to its now tangibly demonstrated bone targeting effects. Alpharadin does seem to have an edge in terms of its adverse effects profile, but as you mention, the manufacturing issues make me think there's plenty of room for Cabo. Plus, the new 40 mg data and unknown OS benefit of Cabo makes it currently unknown how they ultimately stack up.
Right, Dr Vogelzang goes on to state that larger distribution channels are being set up. I was surprised to run into links that stated that there is small quantities of parent actinium-227 available world-wide.
I looked into eligibility requirements for ALSYMPCA trial and I found the following very interesting.
"Patients had to have been treated with docetaxel or be
considered by their physician to be “unfit” for docetaxel, or to refuse docetaxel. Docetaxel is the standard
chemotherapy for metastatic CRPC that has been approved by the FDA since 2004."
Wow!! So docetaxel was a requirement. With that in mind, makes me wonder about Cabo recruitment?