Bisphosphonates, mainly zoledronic acid, have proven efficacy in this situation.[11] Recently, denosumab, a monoclonal antibody targeting the receptor activator of nuclear factor κB (RANK) ligand, has proven superior to zoledronic acid in delaying SREs, and in 2010 it was approved by the US Food and Drug Administration (FDA) for prevention of SREs in patients selleck products with bone metastases of solid tumors.[12] Specifically, denosumab prolonged the time to a pathologic fracture, spinal cord compression, radiation therapy to bone, and surgery to bone, as these were the events defined as SREs and analyzed in the trial.[12]

With a different dosage and schedule of administration, denosumab has also been approved by the FDA as a treatment to increase bone mass in men at high risk of fracture

selleck chemical receiving androgen deprivation therapy for nonmetastatic prostate cancer. Table I summarizes agents that have a proven survival benefit in mCRPC. Table I Summarized view of agents with proven overall survival benefit in metastatic castration-resistant prostate cancer Radium-223 chloride (223-Ra) is an alpha-emitting radiopharmaceutical that delivers high-energy irradiation with a short range, and therefore lower penetration into surrounding tissue than beta-emitting radiopharmaceuticals, such as samarium-153 and strontium-89.[13] In this review, we focus on the AP26113 cost trials involving this radiopharmaceutical, from the Rebamipide initial phase I trial to the pivotal phase III trial recently presented at the European Society of Medical Oncology (ESMO) meeting in 2011. 2. Phase I Trial This trial was published in 2005[14] and recruited a total of 25 patients with bone metastases from breast and prostate cancer (10 females and 15 males). Each of the patients received a single injection of 223-Ra, as part of a cohort dosage escalation schedule. Patients were included at each of the following doses: 46, 93, 163, 213, or 250 kBq/kg, and followed

for 8 weeks. There was no dose-limiting hematotoxicity at any dosage level; reversible myelosupression occurred in some patients, with nadirs 2–4 weeks after injection and full recovery within the 8-week follow-up period. Two patients experienced grade 3 neutropenia; thrombocytopenia was observed only at level 1, even in the highest-dose patients. Other common adverse events (AEs) were transient diarrhea (in 10 of the 25 patients), bone pain, including a ‘flare’ effect (in 9 patients), nausea (in 5 patients) and vomiting (in 5 patients). Seven of the 25 patients had a serious AE (SAE). Five of these were considered to be related to the extent of the malignant disease.