Median OS from the first 223Ra infusion to the last follow-up or death was 8.3 mo (range, 0–44 mo)-nearly 50% less than the ALSYMPCA median survival of 14.9 mo ( P = 0.01). As of August 2020, only 1 patient remained alive after completing 6 cycles of 223Ra. Eleven patients (46%) completed all 6 planned 223Ra infusions 13 (54%) stopped early because of clinical deterioration. Also, before 223Ra, 19 (79%) patients had received docetaxel and 19 (79%) had received 33 courses of radiation, 24 of which targeted nonprostatic sites. In total, 73 sequential combinations of androgen deprivation therapy were used, 68 of which (93%) preceded the first 223Ra infusion. Before the first infusion, all 24 had received androgen deprivation therapy. Results: Twenty-four patients received 98 infusions of 223Ra 83% of these patients were referred from outside WVU. The primary endpoint was patient OS after initiating 223Ra. Median survival in ALSYMPCA and WVU patients was compared using a 2-sided, 1-sample log-rank test based on the exponential distributions.

Standard descriptive statistics were used to study institutional review board–exempted, deidentified patient data. The number of bone metastases per patient at the start of treatment with 223Ra was quantified via nuclear bone scans (12 scans, 5 of which also included SPECT/CT), body CT scans (8 scans), and PET/CT scans (4 scans). Methods: Demographic, clinical, laboratory, and imaging data were reviewed in all bone-predominant mCRPC patients treated with 223Ra at WVU from 2014 to 2019. We performed a retrospective observational study to review our own 223Ra experience at West Virginia University (WVU). However, subsequently reported real-world experience with 223Ra in smaller mCRPC patient cohorts has appeared less successful. The ALSYMPCA trial of the α-emitter 223Ra in symptomatic bone-predominant metastatic castration-resistant prostate cancer (mCRPC) reported a median overall survival (OS) of 14.9 mo, versus 11.3 mo for placebo.

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