Study of Radium-223 for the Palliation of Painful Bone Metastases in Hormone Refractory Prostate Cancer (HRPC) Patients

This study has been completed.
Information provided by:
Algeta ASA Identifier:
First received: April 24, 2008
Last updated: September 8, 2010
Last verified: September 2010

The purpose of this study is to evaluate the efficacy and safety of the investigational radioisotope Radium-223, Alpharadin, in treatment of men with prostate cancer and bone metastases that no longer respond to hormonal treatment

Condition Intervention Phase
Hormone Refractory Prostate Cancer
Bone Metastases
Drug: Alpharadin (Radium-223)
Phase 2

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Investigator)
Primary Purpose: Treatment
Official Title: A Double-blind, Dose-response Phase II, Multicentre Study of Radium-223 (Alpharadin TM ) for the Palliation of Painful Bone Metastases in Hormone Refractory Prostate Cancer Patients

Resource links provided by NLM:

Further study details as provided by Algeta ASA:

Primary Outcome Measures:
  • Pain Assessment (using a 100mm Visual Analogue Scale) [ Time Frame: 16 weeks ] [ Designated as safety issue: No ]
  • Analgesic consumption [ Time Frame: 16 weeks ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Reduction of pain: the pain dimension of Quality of Life assessed using the Brief Pain Inventory (BPI) form, with total pain score and subtotals, after injection and compared to scores at baseline [ Time Frame: 16 weeks ] [ Designated as safety issue: No ]
  • Duration of pain relief: measured as the time between the first and last evaluation time points at which the pain response criteria were met [ Time Frame: 16 weeks ] [ Designated as safety issue: No ]
  • Time to pain progression: measured as time from injection of study drug to pain progression with request for immediate palliative radiotherapy or new systemic palliative treatment [ Time Frame: 16 weeks ] [ Designated as safety issue: No ]
  • The safety of radium-223: the total safety profile including adverse events and clinical laboratory measurements, with emphasis on haematological toxicity. Adverse events will be recorded continuously during the study period. [ Time Frame: 2 years ] [ Designated as safety issue: Yes ]
  • The date of death (if within 24 months after the injection of study drug). [ Time Frame: 2 years ] [ Designated as safety issue: Yes ]

Enrollment: 100
Study Start Date: May 2005
Study Completion Date: October 2009
Primary Completion Date: April 2008 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
1 Drug: Alpharadin (Radium-223)
Alpharadin (radium-223) at different dose levels, 5, 25, 50 or 100 kBq/kg b.w.

Detailed Description:

The study is designed to investigate whether there is a dose-response relationship for radium-223 in patients with painful bone metastases secondary to prostate carcinoma regarding palliation of bone pain. The palliative efficacy will be established through assessments of bone pain and consumption of analgesia.

Furthermore, the aim is to find the most efficient dose with an acceptable safety profile. The safety will be assessed through measurements of adverse events, and acute haematological toxicity during the study period. Long-term chronic toxicity, and the overall survival at one and two years post treatment will also be assessed.

This is a double-blind, dose-response, randomized, multi-centre phase II efficacy and safety study of radium-223. The clinical sites will enroll a total of 100 eligible patients. The treatment is a single intravenous administration of radium-223.

The target population is patients suffering from bone pain due to skeletal metastasis secondary to hormone refractory prostate cancer.


Ages Eligible for Study:   40 Years and older
Genders Eligible for Study:   Male
Accepts Healthy Volunteers:   No

Inclusion criteria:

  1. Histologically/cytologically confirmed adenocarcinoma of the prostate
  2. Patient is hormone refractory with evidence of progressive disease:

    • Patient must be maintained on androgen ablation therapy with LHRH agonist or have undergone orchiectomy
    • Patient's testosterone level is required to be equal to or below 50 ng/dl
    • Patients in which flutamide, nilutamide, megestrol acetate, polyestradiol phosphate, aminoglutethimide, and ketoconazole, has been recently withdrawn must demonstrate progression of disease and be at last 4 weeks beyond the discontinuation of such agents; for bicalutamide 6 weeks is required
    • Increase in PSA levels in two consecutive measurements with at least one week apart, demonstrating an increase over the reference (nadir) value, and with the final PSA >/= 5 ng/ml

      • A reference PSA (nadir) value must be measured at least 4 weeks after the discontinuation of flutamide, nilutamide, megestrol acetate, polyestradiol phosphate, aminoglutethimide, and ketoconazole, and at least 6 weeks after discontinuation of bicalutamide
      • If the third PSA value is lower than the second value, the patient could still be eligible, provided a fourth measurement obtained at least 1 week after the third PSA value, is grater than the second PSA value and >/= 5 ng/ml
  3. Multifocal (>1) skeletal metastases confirmed by bone scintigraphy within 6 weeks
  4. Bone pain with a score of at least 2 on BPI average pain, despite adequate use of analgesics, that correlates with areas of increased uptake (osteoblastic activity) on bone scintigraphy
  5. Performance status: ECOG 0-2 or Karnofsky >/= 60%
  6. Life expectancy: At least 3 months
  7. Age more than 40 years
  8. Laboratory requirements:

    1. Neutrophil count >/= 1,5 x 109/L
    2. Platelet count >/= 100 x109/L
    3. Hemoglobin > 95 g/L
    4. Bilirubin within normal institutional limits
    5. ASAT and ALAT <2,5 times upper limit of normal (ULN)
  9. The patient is willing and able to comply with the protocol (including maintenance of patient diary, completion of pain assessment forms), and agrees to return to the hospital for follow-up visits and examinations
  10. The patient has been fully informed about the study and has signed the informed consent form

Exclusion criteria

  1. Has received an investigational drug within 4 weeks before the administration of radium-223, or is scheduled to receiving one during the study period
  2. Has received chemo-, immunotherapy, or external radiotherapy within the last 4 weeks prior to entering the study, or those who have not recovered from adverse events due to agents administered more than 4 weeks earlier
  3. Has received prior hemibody external radiotherapy
  4. Has received systemic radiotherapy with strontium-89, samarium-153, rhenium-186 or rhenium 188 for the treatment of bony metastases within the last year prior to inclusion
  5. Has started treatment with bisphosphonates less than 3 months prior to administration of study drug
  6. Patients experiencing hormone withdrawal syndrome, or are </= 4 weeks post withdrawal of antiandrogen therapy (6 weeks for bicalutamide)
  7. Patients who have started steroids or changed to treatment with steroids within the last 4 weeks prior to administration of radium-223
  8. Has other clinically significant or symptomatic disease, which might interfere with the assessment of bone pain, e.g. spinal cord compression, compression or infiltration of a neural plexus, nerve root or peripheral nerves
  9. Other currently active (relapse within the last 3 year) malignancy (except non-melanoma skin cancer), or known brain or visceral metastases dominating the clinical picture of the patient
  10. Other serious illness or medical condition:

    • any uncontrolled infection
    • cardiac failure Classification III or IV (New York Heart Association)
    • Crohn disease or Ulcerative colitis
    • known bone fracture within 8 weeks
  Contacts and Locations
Please refer to this study by its identifier: NCT00667199

Hôpital Albert Michallon
Grenoble, France, 38043
Hôpital de la Timone
Marseille, France, 13385
Centre Renè Gauducheau
Nantes, France, 44805
Centre Renè Huguenin
Saint-Cloud, France, 92210
Hôpital Rangueuil
Toulouse, France, 31403
CHU de Nancy
Vandoeuvre les Nancy, France, 54011
Universitätsklinik Aachen
Aachen, Germany, D-52072
Universitätsklinikum des Saarlandes
Homburg/Saar, Germany, D-6421
University Hospital of Schleswig-Holstein
Kiel, Germany, 24105
University Hospital, Dept. of Oncology
Linköping, Sweden, 581 85
Radiumhemmet, Karolinska University Hospital
Stockholm, Sweden, 17176
Länssjukhuset Sundsvall-Härnösand
Sundsvall, Sweden, 85186
United Kingdom
Velindre Hospital
Cardiff, United Kingdom, CF14 2TL
Leicester Royal Infirmary
Leicester, United Kingdom, LE1 5WW
Newcastle General Hospital
Newcastle Upon Tyne, United Kingdom, NE4 6BE
Derriford Hospital
Plymouth, United Kingdom, PL6 8DH
Sponsors and Collaborators
Algeta ASA
Principal Investigator: Sten Nilsson, MD Radiumhemmet, Karolinska University Hospital, 171 76 Stockholm, Sweden
  More Information

No publications provided

Responsible Party: Thomas Ramdahl, President and CEO, Algeta ASA Identifier: NCT00667199     History of Changes
Other Study ID Numbers: BC1-03
Study First Received: April 24, 2008
Last Updated: September 8, 2010
Health Authority: Germany: Federal Institute for Drugs and Medical Devices
Sweden: Medical Products Agency
United Kingdom: Medicines and Healthcare Products Regulatory Agency
France: Afssaps - Agence française de sécurité sanitaire des produits de santé (Saint-Denis)

Keywords provided by Algeta ASA:
Hormone Refractory Prostate Cancer
Bone Metastases
Palliation of bone pain

Additional relevant MeSH terms:
Neoplasm Metastasis
Neoplasms, Second Primary
Prostatic Neoplasms
Bone Neoplasms
Bone Marrow Diseases
Neoplastic Processes
Pathologic Processes
Genital Neoplasms, Male
Urogenital Neoplasms
Neoplasms by Site
Genital Diseases, Male
Prostatic Diseases
Bone Diseases
Musculoskeletal Diseases
Hematologic Diseases
Hormones, Hormone Substitutes, and Hormone Antagonists
Physiological Effects of Drugs
Pharmacologic Actions processed this record on April 21, 2014