Table 2.
Summary of various guidelines´ recommendations for the use of radium-223 in metastatic prostate cancer. (CRPC = castration-resistant prostate cancer, QALY = quality adjusted life years)
| Reference | Institution | Conclusions |
|---|---|---|
| Horwich et al., 2013. | European Society of Medical Oncology (ESMO). | Recommend bone targeted therapy with one of the beta particle emitting radio-nucleotides should be considered for patients with painful bone metastases. Ra-223 may become a new treatment option for symptomatic patients. |
| Casinello et al., 2014 | Sociedad Española de Oncología Médica (SEOM). | Recommend patients with only bone disease and nodes less than 2 cm to be considered for radium-223. |
| Basch et al., 2014. | American Society of Clinical Oncology (ASCO) and Cancer Care Ontario (CCO). | Recommend radium-223 offered to men with bone metastases and state that cost-effectiveness assessment is not included in their guideline. |
| Mohler et al., 2013 | National Comprehensive Cancer Network (NCCN). | A favourable toxicity profile and extension of survival renders radium-223 an attractive first-line or second-line option for patients with symptomatic bone metastases and no known visceral disease. Radium-223 given in combination with chemotherapy outside clinical trials is not recommended. |
| Heidenreich et al., 2014. | European Association of Urology (EAU). | Radium-223 is available for second-line treatment of CRPC following docetaxel. |
| Norwegian Directorate of Health, 2014. | Norwegian Directorate of Health. | The use of isotopes may be considered for patients with symptomatic bone metastases when external radiotherapy has limited effect and docetaxel has been considered/used. Ra-223 has documented effect, but is not licensed and has not undergone national cost-effectiveness analysis. |
| Swedish National Board for Health and Welfare, 2014 | Swedish National Board for Health and Welfare. | Radium-223 may be indicated in patients with mCRPC with skeletal metastases and following chemotherapy (when appropriate). High evidence of effect, but cost per QALY is very high. The figures are uncertain. |