Prostatic NeoplasmsPhase 3ERA 223NCT02043678
Radium-223 Dichloride and Abiraterone Acetate Compared to Placebo and Abiraterone Acetate for Men With Cancer of the Prostate When Medical or Surgical Castration Does Not Work and When the Cancer Has Spread to the Bone, Has Not Been Treated With Chemotherapy and is Causing no or Only Mild Symptoms
A Phase 3 study testing Radium-223 dichloride (Xofigo, BAY88-8223), Abiraterone and Prednisone/Prednisolone in people with Prostatic Neoplasms, run by Bayer at 163 sites in 19 countries.
Trial summary
To determine if the addition of radium-223 dichloride to standard treatment is able to prolong life and to delay events specific for prostate cancer which has spread to the bone, such as painful fractures or bone pain which needs to be treated with an X-ray machine. Read more about this study
- Who is it for?
- Ages 18 years and older, men only
- Conditions the study is for
- Prostatic Neoplasms
- What is being tested?
- Radium-223 dichloride (Xofigo, BAY88-8223), Abiraterone and Prednisone/Prednisolone
- Type of treatment
- Pill or oral medicine, Injection or infusion
- Could I receive a placebo?
- Yes, some participants may receive a placebo
- How many people
- 806 participants
- Where
- 163 sitesin 19 countries
- Study dates
- 30 Mar 2014to 8 Feb 2024
- Phase
- Phase 3
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- Men only
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Histologically confirmed adenocarcinoma of the prostate
- Male subjects of age ≥ 18 years
- Prostate cancer progression documented by prostate specific antigen (PSA) according to the Prostate Cancer Working Group 2 (PCWG2) criteria or radiological progression according to Response Evaluation Criteria in Solid Tumors (RECIST), version 1.1
- Two or more bone metastases on bone scan within 4 weeks prior to randomization with no lung, liver, other visceral and/or brain metastasis
- Asymptomatic or mildly symptomatic prostate cancer
- Subjects who received combined androgen blockade with an anti-androgen must have shown PSA progression after discontinuing the anti-androgen prior to enrollment
- Maintenance of medical castration or surgical castration with testosterone less than 50 ng/dL (1.7nmol/L)
- Eastern Cooperative Oncology Group performance status (ECOG PS) score 0 or 1
Who cannot join
- Prior cytotoxic chemotherapy for the treatment of CRPC, including taxanes, mitoxantrone and estramustine
- Any chronic medical condition requiring a higher dose of corticosteroid than 5 mg prednisone/prednisolone twice daily
- Pathological finding consistent with small cell carcinoma of the prostate
- History of visceral metastasis, or presence of visceral metastasis detected by screening imaging examinations
- History of or known brain metastasis
- Malignant lymphadenopathy exceeding 3 cm in short-axis diameter
Show all 9Show fewer
- Blood transfusion or erythropoietin stimulating agents prior 4 weeks of screening and during the whole screening period before randomization
- Imminent spinal cord compression based on clinical findings and/or magnetic resonance imaging (MRI). Subjects with history of spinal cord compression should have completely recovered
- Use of opiate analgesics for cancer-related pain, including codeine and dextropropoxyphene, currently or anytime during the 4- week period prior to randomization.
Trial locations and contacts
163 sites in 19 countries.
163 sites in 19 countries
United States29 sites
Study site
Anchorage, Alaska, 99503
Study site
Atlanta, Georgia, 30322
Study site
Bala-Cynwyd, Pennsylvania, 19004
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Baltimore, Maryland, 21201
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Boston, Massachusetts, 02114-2696
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Burlington, Massachusetts, 1805
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Denver, Colorado, 80211
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Detroit, Michigan, 48202
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Fort Myers, Florida, 33901
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Hackensack, New Jersey, 7601
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Jeffersonville, Indiana, 47130
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Las Vegas, Nevada, 89169
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New Orleans, Louisiana, 70112
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Norfolk, Virginia, 23502
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Oceanside, California, 92056
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Omaha, Nebraska, 68130
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Pittsburgh, Pennsylvania, 15215
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Pittsburgh, Pennsylvania, 15240
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Poughkeepsie, New York, 12601
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Rockville, Maryland, 20850
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Seattle, Washington, 98109-1023
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Spokane, Washington, 99208-1129
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St Louis, Missouri, 63110
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Syracuse, New York, 13210
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Towson, Maryland, 21204
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Traverse City, Michigan, 49684
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Tucson, Arizona, 85718
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Washington D.C., District of Columbia, 20007-2113
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Wheeling, West Virginia, 26003
Japan29 sites
Study site
Bunkyo-ku, Tokyo, 113-8431
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Bunkyo-Ku, Tokyo, 113-0022
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Chiba, Chiba, 260-8677
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Chiba, 260-8717
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Fukuoka, 811-1395
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Fukuoka, 812-8582
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Hamamatsu, Shizuoka, 431-3192
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Hirosaki, Aomori, 036-8563
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Kanazawa, Ishikawa-ken, 920-8641
Study site
Kashiwa, Chiba, 277-8577
Study site
Kita-gun, Kagawa-ken, 761-0793
Study site
Kobe, Hyōgo, 650-0047
Study site
Koto-ku, Tokyo, 135-8550
Study site
Kumamoto, 860-0008
Study site
Kurashiki, Okayama-ken, 701-0192
Study site
Matsumoto, Nagano, 390-8621
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Matsuyama, Ehime, 791-0280
Study site
Miyazaki, 889-1692
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Nagasaki, 852-8501
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Nagoya, Aichi-ken, 466-8560
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Okayama, Okayama-ken, 700-8558
Study site
Sapporo, Hokkaido, 003-0804
Study site
Sayama, Osaka, 589-8511
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Sendai, Miyagi, 980-8574
Study site
Shinjuku-ku, Tokyo, 160-8582
Study site
Tsukuba, Ibaraki, 305-8576
Study site
Ube, Yamaguchi, 755-8505
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Yokohama, Kanagawa, 236-0004
Study site
Yokohama, Kanagawa, 241-8515
Spain13 sites
Study site
Badalona, Barcelona, 8916
Study site
Barcelona, 08035
Study site
Barcelona, 8036
Study site
L'Hospitalet de Llobregat, Barcelona, 08907
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Madrid, 28009
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Madrid, 28033
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Madrid, 28034
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Madrid, 28046
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Madrid, 28050
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Málaga, Málaga, 29010
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Oviedo, Principality of Asturias, 33011
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Pamplona, 31008
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Seville, 41071
United Kingdom11 sites
Study site
Bebington, Merseyside, CH63 4JY
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Belfast, BT9 7AB
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Coventry, West Midlands, CV2 2DX
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Edinburgh, Lothian, EH4 2XU
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Guildford, Surrey, GU2 7XX
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Leeds, LS9 7TF
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London, NW3 2QG
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Newcastle upon Tyne, Tyne and Wear, NE4 6BE
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Northwood, Middlesex, HA6 2VR
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Romford, RM7 0AG
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Sutton, Surrey, SM2 5PT
Israel9 sites
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Afula, 1834111
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Beersheba, 8410101
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Haifa, 3109601
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Jerusalem, 9112001
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Kfar Saba, 4428164
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Petah Tikva, 4941492
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Ramat Gan, 5262000
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Tel Aviv, 6423906
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Ẕerifin, 7030000
Italy9 sites
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Cagliari, Sardinia, 9125
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Cortona, Tuscany, 52040
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Genoa, Liguria, 16128
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Milan, Lombardy, 20133
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Milan, Lombardy, 20141
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Modena, Emilia-Romagna, 41100
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Rome, Lazio, 152
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Rome, Lazio, 189
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Trento, Trentino-Alto Adige, 38100
Australia8 sites
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Adelaide, South Australia, 5000
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East Bentleigh, Victoria, 3165
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East Melbourne, 3002
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Fitzroy, Victoria, 3065
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Heidelberg, Victoria, 3084
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Randwick, 2031
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St Leonards, New South Wales, 2065
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Sydney, New South Wales, 2010
Canada8 sites
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Calgary, Alberta, T2N 4N2
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Hamilton, Ontario, L8V 5C2
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Montreal, Quebec, H2L 4M1
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Ottawa, Ontario, K1H 8L6
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Québec, Quebec, G1R 2J6
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Toronto, Ontario, M4N 3M5
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Vancouver, British Columbia, V5Z 4E6
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Winnipeg, Manitoba, R3A 1R9
France7 sites
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Besançon, 25030
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Bordeaux, 33076
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Paris, 75005
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Paris, 75010
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Poitiers, 86021
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Saint-Herblain, 44800
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Toulouse, 31059
Germany7 sites
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Berlin, 12203
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Dresden, Saxony, 1307
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Jena, Thuringia, 7747
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Marburg, Hesse, 35033
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München, Bavaria, 81675
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Münster, North Rhine-Westphalia, 48149
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Ulm, Baden-Wurttemberg, 89075
Brazil5 sites
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Barretos/SP, São Paulo, 14784-400
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Belo Horizonte, Minas Gerais, 30130-090
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Porto Alegre, Rio Grande do Sul, 90020-090
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São Paulo, São Paulo, 01246-000
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São Paulo, 01409-000
Sweden5 sites
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Linköping, 581 85
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Stockholm, 171 76
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Sundsvall, 851 86
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Umeå, 901 85
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Vaxjo, 351 85
Belgium4 sites
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Brussels, 1070
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Bruxelles - Brussel, 1200
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Edegem, 2650
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Ghent, 9000
Finland4 sites
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Helsinki, FIN-00260
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Kuopio, FIN- 70029
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Seinäjoki, 60220
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Tampere, 33520
Poland4 sites
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Gdansk, 80-214
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Gdynia, 81-519
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Gliwice, 44-101
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Poznan, 61-485
Netherlands3 sites
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Amsterdam, 1105 AZ
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Nijmegen, 6525 GA
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Zwolle, 8025 AB
Norway3 sites
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Bodø, 8092
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Lørenskog, 1478
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Oslo, 450
Singapore3 sites
Study site
Singapore, 119074
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Singapore, 168583
Study site
Singapore, 258499
About this study
Official title: A Phase III Randomized, Double-blind, Placebo-controlled Trial of Radium-223 Dichloride in Combination With Abiraterone Acetate and Prednisone/Prednisolone in the Treatment of Asymptomatic or Mildly Symptomatic Chemotherapy-naïve Subjects With Bone Predominant Metastatic Castration-resistant Prostate Cancer(CRPC)
To determine if the addition of radium-223 dichloride to standard treatment is able to prolong life and to delay events specific for prostate cancer which has spread to the bone, such as painful fractures or bone pain which needs to be treated with an X-ray machine.
Read the detailed description
This study is a phase III multinational, multicenter,randomized, double blind, placebo controlled, study with a randomization allocation ratio of 1:1 (radium-223 dichloride plus abiraterone acetate plus prednisone/prednisolone: placebo plus abiraterone acetate plus prednisone/prednisolone). Until the final overall survival (OS) analysis, the study period consisted of screening / randomization, treatment, active follow-up with clinic visits, active follow-up without clinic visits, and longterm follow-up phases. Up until this point, subjects received study treatment (radium-223 dichloride or placebo in addition to abiraterone acetate plus prednisone / prednisolone for the first 6 cycles followed by abiraterone acetate plus prednisone / prednisolone thereafter) until an on-study SSE occurred (or other withdrawal criteria were met). After the final OS analysis (after implementation of Amendment 7), in order to reduce the burden to study subjects, evaluation of efficacy and exploratory endpoints will be discontinued, except for symptomatic skeletal event (SSE) and OS. Subjects who are discontinued from study treatment will initiate the long-term follow-up period; therefore, active follow-up periods will no longer be applicable. Subjects who are in active follow-up at the time of Amendment 7 is implemented should have the end of active follow-up completed (protocol driven decision) and should be directly transitioned into the extended safety follow-up study. Long term follow-up will continue until the subject dies, is lost to follow-up, withdraws informed consent, actively objects to collection of further data , or is transitioned to the extended safety follow-up study. Subjects will be followed for safety for up to 7 years, which eventually will be completed in this study or in the extended safety follow-up study.
- Conditions
- Prostatic Neoplasms
- Being tested
- Radium-223 dichloride (Xofigo, BAY88-8223), Matching placebo (normal saline), Abiraterone, Prednisone/Prednisolone
- Keywords
- Phase III, Radium-223 dichloride, Abiraterone acetate, Combination therapy, Chemotherapy-naive, Bone metastasis, Castration-resistant prostate cancer (CRPC)
- Medical subject headings
- Prostatic Neoplasms
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Radium-223 dichloride (Xofigo, BAY88-8223)Drug
50 kiloBecquerel per kilogram (kBq/kg) (55 kBq/kg after implementation of NIST update) body weight, intravenous injection (IV-slow bolus), every 4 weeks for 6 cycles
Matching placebo (normal saline)Drug
Intravenous injection ( IV-slow bolus), every 4 weeks for 6 cycles
AbirateroneDrug
1000 mg once daily, oral, with best supportive care
Prednisone/PrednisoloneDrug
5 mg twice daily, oral, with best supportive care
| Study group | Role | What they receive |
|---|---|---|
| Radium-223 dichloride + Abi/Pred | Experimental | Participants received 6 intravenous (IV) administrations of radium-223 dichloride 50 kiloBecquerel per kilogram (kBq/kg) (55 kBq/kg after implementation of National Institute of Standards and Technology [NIST] update) body weight at intervals of 4 weeks, along with oral abiraterone acetate tablets 1000 milligrams (mg) every day plus prednisone/prednisolone 5 mg twice daily (abi/pred) for 6 cycles, followed by abi/pred until an on-study symptomatic skeletal event (SSE) occurred (or other withdrawal criteria were met) Receives: Drug: Radium-223 dichloride (Xofigo, BAY88-8223); Drug: Abiraterone; Drug: Prednisone/Prednisolone |
| Placebo + Abi/Pred | Placebo comparator | Participants received 6 IV administrations of placebo matched to radium-223 dichloride at intervals of 4 weeks, along with abi/pred for 6 cycles, followed by abi/pred until an on-study SSE occurred (or other withdrawal criteria were met) Receives: Drug: Matching placebo (normal saline); Drug: Abiraterone; Drug: Prednisone/Prednisolone |
What is being measured
The primary outcome is the main question the study is designed to answer.
Symptomatic Skeletal Event Free Survival (SSE-FS)
SSE-FS was defined as time (months) from randomization to the earliest of onset date of skeletal symptoms treated with external beam radiotherapy (EBRT), onset date of pathological bone fracture, onset date of spinal cord compression, procedure date of tumor-related orthopedic surgery, or death from any cause. Participants who died without prior SSE and ≥ 13 weeks after the last SSE assessment are censored at the last SSE assessment date. Participants alive at the survival cut-off date are censored at the last date known to be alive. Participants with multiple events are only counted for the category in which the first event occurred. If multiple SSE (component events) occur on the same date for 1 participant, the participant is only counted into 1 category in the order of: spinal cord compression > bone fracture > orthopedic surgery > EBRT.
Measured: From randomization until first onset of on-study symptomatic skeletal event (SSE) or death, up to 47 months
Secondary outcomes (14)
Overall Survival (OS)
OS was defined as the time (months) from the date of randomization to the date of death due to any cause. Participants alive at the survival cut-off date were censored at the last date known to be alive.
Measured: From randomization until death from any cause, up to 67 months
Radiological Progression Free Survival (rPFS)
rPFS was defined as the time (months) from the date of randomization to the date of confirmed radiological progression or death (if death occurred before progression) based on independent assessment.
Measured: From randomization until the date of confirmed radiological progression or death, up to 47 months
Time to Pain Progression
Time to pain progression was defined as the interval from randomization to the first date a participant experienced pain progression assessed by Brief Pain Inventory-Short Form and defined as: an increase of 2 or more points in the average worst pain score (WPS) from baseline observed at 2 consecutive evaluations ≥4 weeks apart or initiation of short- or long-acting opioid use for pain for participants with WPS 0 at baseline; an increase of 2 or more points in the average WPS from baseline observed at 2 consecutive evaluations ≥4 weeks apart and an average WPS of ≥4 OR initiation of short- or long-acting opioid use for pain for participants with WPS 1 to 3 at baseline. Participants without pain progression at end of study are censored at the last date known to have not progressed: last evaluation date for pain scores or last visit when recorded opiate use, whichever is last. Participants with no on-study assessment or no baseline assessment are censored at the date of randomization.
Measured: From randomization until the date of pain progression based on pain score, up to 47 months
Time to Cytotoxic Chemotherapy
Time to cytotoxic chemotherapy is time (months) from randomization to the earliest date of the first cytotoxic chemotherapy. Participants who have not started cytotoxic chemotherapy during the study were censored at the last assessment date.
Measured: From randomization until the date of first cytotoxic chemotherapy, up to 47 months
Time to Opiate Use for Cancer Pain
Time to opiate use for cancer pain was defined as the interval from the date of randomization to the date of opiate use.
Measured: From randomization until the date of opiate use, up to 47 months
Number of Participants With Treatment-emergent Adverse Events
An adverse event (AE) was any untoward medical occurrence (i.e., any unfavorable and unintended sign [including abnormal laboratory findings], symptom or disease) in a participant in the study. A serious adverse event (SAE) was any untoward medical occurrence that at any dose was resulting in death, was life-threatening, requires hospitalization or prolongation of existing hospitalization, resulted in persistent or significant disability/incapacity. A treatment-emergent AEs (TEAEs) or serious TEAEs was defined as any event that started on or after the first dose of the study treatment and during the treatment period and was not a continuation of a pretreatment event or started before the first dose and worsened after the first dose or the treatment period. Drug-related TEAEs or serious TEAEs were those with "reasonable causal relationship" to the study treatment decided by the investigators.
Measured: From start of study treatment until the end of the treatment period, up to 110 months
Number of Participants With Radium-223/Placebo-related Treatment-emergent Adverse Events Per Maximum Intensity
An adverse event (AE) was any untoward medical occurrence (i.e., any unfavorable and unintended sign [including abnormal laboratory findings], symptom or disease) in a participant in the study. A serious adverse event (SAE) was any untoward medical occurrence that at any dose was resulting in death, was lifethreatening, requires hospitalization or prolongation of existing hospitalization, resulted in persistent or significant disability/incapacity. A treatment-emergent AEs (TEAEs) or serious TEAEs was defined as any event that started on or after the first dose of the study treatment and during the treatment period and was not a continuation of a pretreatment event or started before the first dose and worsened after the first dose or the treatment period. Radium-223/placebo-related TEAEs or serious TEAEs were those with "reasonable causal relationship" to radium-223 or placebo decided by the investigators.
Measured: From start of study treatment until the end of the treatment period, up to 110 months
Number of Participants With Any Treatment-emergent Additional Primary Malignancies
Treatment-emergent additional primary malignancies were adverse events identified as additional primary malignancies that occurred after start of study treatment until the end of the treatment period.
Measured: From start of study treatment until the end of the treatment period, up to 110 months
Number of Participants With Treatment-emergent Bone Fractures
Treatment-emergent fractures were adverse events identified as fractures that occurred after start of study treatment until the end of the treatment period. All bone fractures and bone-associated events (e.g., osteoporosis) were reported as either AEs, or SAEs if the criteria of SAE were met, regardless of the investigator's causality assessment.
Measured: From start of study treatment until the end of the treatment period, up to 110 months
Number of Participants With Post-treatment Adverse Events
An adverse event (AE) was any untoward medical occurrence (i.e., any unfavorable and unintended sign [including abnormal laboratory findings], symptom or disease) in a participant in the study. Any bleeding event occurring during the study was not documented as an AE because this event was planned to be captured in the assessment of efficacy. AEs that started after the treatment period were defined as post-treatment AEs. Drug-related AEs were those with "reasonable causal relationship" to the study treatment decided by the investigators.
Measured: After the treatment period, up to 48.5 months in active follow-up and 74.9 months in long-term follow-up
Number of Participants With Any Study Drug-related Post-treatment Adverse Events Per Maximum Intensity
An adverse event (AE) was any untoward medical occurrence (i.e., any unfavorable and unintended sign [including abnormal laboratory findings], symptom or disease) in a participant in the study. Any bleeding event occurring during the study was not documented as an AE because this event was planned to be captured in the assessment of efficacy. AEs that started after the treatment period were defined as post-treatment AEs. Drug-related AEs were those with "reasonable causal relationship" to the study treatment decided by the investigators.
Measured: After the treatment period, up to 48.5 months in active follow-up and 74.9 months in long-term follow-up
Number of Participants With Post-treatment Additional Primary Malignancies
Post-treatment additional primary malignancies were adverse events identified as additional primary malignancies that started after the treatment period.
Measured: After the treatment period, up to 48.5 months in active follow-up and 74.9 months in long-term follow-up
Number of Participants With Post-treatment Chemotherapy-related Blood and Lymphatic System Disorders
Post-treatment blood and lymphatic system disorders were adverse events identified as blood and lymphatic system disorders that occurred after the end of the treatment period until participant died, was lost to follow-up, withdrew informed consent, actively objected to collection of further data, or was transitioned to the extended safety follow-up study.
Measured: After the treatment period, up to 48.5 months in active follow-up and 74.9 months in long-term follow-up
Number of Participants With Post-treatment Bone Fractures
Post-treatment fractures were adverse events identified as fractures that occured after the end of the treatment period until participant died, was lost to follow-up, withdrew informed consent, actively objected to collection of further data, or was transitioned to the extended safety follow-up study. All bone fractures and bone-associated events (e.g., osteoporosis), were reported as either AEs, or SAEs if the criteria of SAE were met, regardless of the investigator's causality assessment.
Measured: After the treatment period, up to 48.5 months in active follow-up and 74.9 months in long-term follow-up
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted23 Jan 2014 (estimated)
- Study start30 Mar 2014
- Primary completion15 Feb 2018
- Study completion8 Feb 2024
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Posted resultsParticipant flow, outcome measures and adverse events reported by the sponsor.
- Publications (3)Papers the sponsor has linked to this study.
- Other trials for Prostatic NeoplasmsStudies of the same condition, open and under way.
- More trials run by BayerThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase 3
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Quadruple blind
- Who is masked
- Participant, Care provider, Investigator, Outcomes assessor
- Enrolment
- 806 participants (actual)
Sponsor and investigators
- Lead sponsor
- Bayer
- Sponsor type
- Industry (pharma, biotech, devices)
- Collaborators
- Janssen Research & Development, LLC
- Responsible party
- Sponsor
- Investigators
- Bayer Study Director, Study director, Bayer
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT02043678
- Sponsor's protocol ID
- 15396
- Other IDs
- 2013-003438-33
- Acronym
- ERA 223
- Status last verified
- Jan 2025
- First submitted
- 21 Jan 2014
- Last updated
- 19 Feb 2025
- Results posted
- Yes, on ClinicalTrials.gov
- Data monitoring committee
- Yes
- FDA-regulated device
- No
- Individual data sharing
- No: Availability of this study's data will later be determined according to Bayer's commitment to the EFPIA/PhRMA "Principles for responsible clinical trial data sharing". This pertains to scope, timepoint and process of data access. As such, Bayer commits to sharing upon request from qualified researchers patient-level clinical trial data, study-level clinical trial data, and protocols from clinical trials in patients for medicines and indications approved in the US and EU as necessary for conducting legitimate research. This applies to data on new medicines and indications that have been approved by the EU and US regulatory agencies on or after January 01, 2014. Interested researchers can use www.vivli.org to request access to anonymized patient-level data and supporting documents from clinical studies to conduct research. Information on the Bayer criteria for listing studies and other relevant information is provided in the member section of the portal.
Publications
Smith M, Parker C, Saad F, Miller K, Tombal B, Ng QS, Boegemann M, Matveev V, Piulats JM, Zucca LE, Karyakin O, Kimura G, Matsubara N, Nahas WC, Nole F, Rosenbaum E, Heidenreich A, Kakehi Y, Zhang A, Krissel H, Teufel M, Shen J, Wagner V, Higano C. Addition of radium-223 to abiraterone acetate and prednisone or prednisolone in patients with castration-resistant prostate cancer and bone metastases (ERA 223): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Oncol. 2019 Mar;20(3):408-419. doi: 10.1016/S1470-2045(18)30860-X. Epub 2019 Feb 6.
PubMed 30738780Shore N, Higano CS, George DJ, Sternberg CN, Saad F, Tombal B, Miller K, Kalinovsky J, Jiao X, Tangirala K, Sartor O. Concurrent or layered treatment with radium-223 and enzalutamide or abiraterone/prednisone: real-world clinical outcomes in patients with metastatic castration-resistant prostate cancer. Prostate Cancer Prostatic Dis. 2020 Dec;23(4):680-688. doi: 10.1038/s41391-020-0236-0. Epub 2020 May 13.
PubMed 32404868Matsubara N, Kimura G, Uemura H, Uemura H, Nakamura M, Nagamori S, Mizokami A, Kikukawa H, Hosono M, Kinuya S, Krissel H, Siegel J, Kakehi Y. A randomized, double-blind, comparison of radium-223 and placebo, in combination with abiraterone acetate and prednisolone, in castration-resistant metastatic prostate cancer: subgroup analysis of Japanese patients in the ERA 223 study. Int J Clin Oncol. 2020 Apr;25(4):720-731. doi: 10.1007/s10147-019-01589-6. Epub 2019 Dec 10.
PubMed 31823152