PEACE-3 OS Data Support Radium-223 Plus Enzalutamide in Metastatic Castration-Resistant Prostate Cancer
Key Points
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In the phase 3 EORTC 1333/PEACE-3 trial, radium-223 plus enzalutamide improved median overall survival (OS) and radiographic progression-free survival (rPFS) in patients with metastatic castration-resistant prostate cancer (mCRPC) with bone metastases.
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Most patients in the trial population were androgen receptor pathway inhibitor (ARPI)-naïve, which does not reflect current standard practice in mCRPC.
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Radium-223 is typically well tolerated, but cytopenias remain a major safety concern.
At an event coinciding with the 2026 ASCO Genitourinary Cancers Symposium, final overall survival data from the EORTC 1333/PEACE-3 trial evaluating radium-223 plus enzalutamide in patients with mCRPC were presented. Sindhuja Kadambi, MD, MS, of University of Rochester, and Karine Tawagi, MD, of University of Illinois, discussed the significance of the findings and who may be the best candidate for this treatment.
Compared with enzalutamide alone (32.6 months), the enzalutamide and radium-223 arm demonstrated a median OS of 38.2 months. Furthermore, the OS benefit was consistent across most predefined subgroups. The study also showed a significant improvement in rPFS with the combination delaying disease progression by 3 months.
However, Dr. Tawagi emphasized that most patients in the study had limited prior exposure to ARPI, so the trial population may not fully represent the current treatment landscape for mCRPC.
Despite these limitations, radium-223 may still benefit certain patients. The therapy is for patients with symptomatic bone-only metastatic disease, and bone health considerations are essential to care, Dr. Tawagi said. The most important safety concerns are cytopenias, mild fatigue, and gastrointestinal effects.