Xofigo (radium Ra-223 dichloride) / Bayer - LARVOL DELTA

Targeted Alpha Therapy as a Multiscale Design Problem: From Radioactive Decay to Therapeutic Outcome. (PubMed, Pharmaceuticals (Basel)) - "Established and emerging alpha emitters, including radium-223, astatine-211, lead-212/bismuth-212, actinium-225/bismuth-213, thorium-227 and terbium-149, are examined as distinct design solutions rather than interchangeable therapeutic options. Their comparison shows that no single radionuclide is universally optimal, as each occupies a distinct position within a landscape defined by physical, chemical and biological constraints. Viewing TAT as a multiscale design problem shifts radionuclide selection from the search for a universally superior emitter toward the rational matching of radionuclide properties to therapeutic context."

Journal • Review

Radium 223 Dichloride : A Re-Audit of Patient Response and Survival (ESMO 2026) - No abstract available

Clinical • Oncology

Efficacy of Actinium-225 versus Radium-223 as the first nuclide for the treatment of metastatic castrate-resistant prostate cancer: a systemic review and meta-analysis (ESMO 2026) - No abstract available

Metastases • Retrospective data • Review • Castration-Resistant Prostate Cancer • Genito-urinary Cancer • Oncology • Prostate Cancer • Solid Tumor

Development of a nomogram for overall survival prediction in metastatic castration-resistant prostate cancer (mCRPC) patients treated with Radium-223: A single center retrospective study (ESMO 2026) - No abstract available

Metastases • Retrospective data • Castration-Resistant Prostate Cancer • Genito-urinary Cancer • Oncology • Prostate Cancer • Solid Tumor

Baseline genomic landscape and disease burden correlates in bone-metastatic castration resistant prostate cancer: Results from the phase 2 COMRADE trial of radium-223 ± olaparib (ESMO 2026) - No abstract available

Metastases • P2 data • Castration-Resistant Prostate Cancer • Genito-urinary Cancer • Oncology • Prostate Cancer • Solid Tumor

Safety of Spine Radiotherapy Delivered within 6 Months of Lu-177 PSMA Radioligand Therapy in Metastatic Prostate Cancer (ASTRO 2026) - "Median prior systemic therapy lines was 3 (IQR 2-4) and included taxanes (100%), olaparib (24%), platinum (17%), and radium-223 (15%); patients who received endocrine therapy (both ADT and ARPI) and 3 other lines of systemic therapy were defined as heavily pretreated (35%). In this cohort treated with spine RT and Lu-177 PSMA RLT, severe toxicity was primarily hematologic with no high-grade spine RT-site complications. G3+ AE were associated with cumulative RLT exposure rather than RT sequencing or extent of spine treatment, supporting the safety of integrating these modalities. Longer follow-up is needed to fully characterize the safety conclusion."

Clinical • Metastases • Genito-urinary Cancer • Oncology • Prostate Cancer • Solid Tumor

Mechanistic Insights into Radiopharmaceutical Therapy Resistance through Bayesian Analysis of Circulating Tumor Cell Transcriptomes (ASTRO 2026) - "Purpose/Objective(s): The radiopharmaceutical radium-223 (Ra 223) improves survival in metastatic prostate cancer, but not all patients respond and resistance mechanisms are poorly understood... Activated OXPHOS was significantly correlated with poor survival after Ra 223 in metastatic prostate cancer. These findings support the potential of CTC analyses to identify radiopharmaceutical resistance mechanisms, although further validation is needed."

Circulating tumor cells • Tumor cell • Genito-urinary Cancer • Oncology • Prostate Cancer • Solid Tumor • CTCs • STEAP2

Magnetic Resonance Imaging (MRI) Radiomics that Predicts the Treatment Outcome in a Phase 2 Trial of Ra-223 Combined with Stereotactic Body Radiation Therapy and Androgen Deprivation Therapy (ADT) for Oligometastatic Castrate Sensitive Prostate Cancer (ASTRO 2026) - "In this study including 13 patients with oligometastatic CSPC underwent combined treatment of Xofigo, SBRT and ADT, pre-treatment T1 radiomics were found to have significant predictive values for future systemic progression, and these T1 radiomic features are mostly related to tumor heterogeneity and texture uniformity."

Clinical • Metastases • MRI • P2 data • Genito-urinary Cancer • Oncology • Prostate Cancer • Solid Tumor

Longitudinal ctDNA tumor fraction (TF) as a prognostic biomarker in bone-dominant metastatic castration-resistant prostate cancer (mCRPC) treated with radium-223 ± olaparib: Results from the phase 2 COMRADE trial. (ESMO 2026) - No abstract available

Biomarker • Circulating tumor DNA • Metastases • P2 data • Castration-Resistant Prostate Cancer • Genito-urinary Cancer • Oncology • Prostate Cancer • Solid Tumor

Radium-223 in metastatic castration-resistant prostate cancer: real-world treatment patterns and overall survival by line of therapy in Spain (PROFIT study) (ESMO 2026) - No abstract available

Clinical • HEOR • Metastases • Real-world • Real-world evidence • Castration-Resistant Prostate Cancer • Genito-urinary Cancer • Oncology • Prostate Cancer • Solid Tumor

Addition of darolutamide to first line treatment of metastatic castration-resistant prostate cancer (mCRPC): A randomized open label phase II trial (SAKK 08/23). (ASCO-GU 2025) - P2 | "Funded by State secretariat for education, research and information (SERI) Switzerland Clinical Trial Registration Number: NCT06401980 Background: The implementation of androgen-receptor pathway inhibitors (ARPI) +/- docetaxel (doce) in addition to androgen deprivation therapy (ADT) in metastatic hormone sensitive prostate cancer (mHSPC) has limited the therapeutic options in the mCRPC setting...Continuing enzalutamide in addition to doce versus a switch to doce alone after progression on enzalutamide in later line mCRPC has been demonstrated to prolong PFS in a phase 3 trial...Patients will be randomized 1:1 to receive physician's choice standard of care (SOC: doce, cabazitaxel, 177lutetium-PSMA, radium-223 or olaparib) or SOC with daro...The trial will enroll pts in Switzerland and Spain. Accrual to the study is currently ongoing."

Clinical • Metastases • P2 data • Castration-Resistant Prostate Cancer • Genito-urinary Cancer • Hormone Sensitive Prostate Cancer • Oncology • Prostate Cancer • Solid Tumor

Long-term safety of radium-223 (Ra-223) in metastatic castration-resistant prostate cancer (mCRPC): 7-year follow-up from the largest global prospective study. (ASCO 2025) - P | "Prior treatments included abiraterone (48% of pts), enzalutamide (39%), docetaxel (39%), and cabazitaxel (9%). This real-world safety analysis of pts with mCRPC is the longest follow-up of a radiopharmaceutical reported to date and supports the well-established favorable safety profile of Ra-223. The incidence of SPMs was low. The rate of fracture was low, especially in the presence of BHAs."

Clinical • Metastases • Castration-Resistant Prostate Cancer • Genito-urinary Cancer • Musculoskeletal Diseases • Oncology • Orthopedics • Prostate Cancer • Solid Tumor

Combined treatment with radium-223 (RAD) and enzalutamide (ENZ) in patients (pts) with metastatic castration-resistant prostate cancer (mCRPC): Insights from the global REASSURE study (ESMO 2025) - P, P3 | "Incidence of fractures was slightly higher in ALL pts (10%) with fewer pts receiving concomitant BPAs (denosumab 28% and zoledronic acid 13%)...Table: 2401P ENZ/RAD (N=45) ALL Pts (N=1,472) Median time since initial diagnosis of bone metastases to study entry, months 14 23 Median time since castration resistant cancer to study entry, months 7 13 Extent of disease, % Bone only metastases 80 81 Bone metastases + lymph node only 9 13 Disease burden, % 20 metastases but not Superscan 18 20 Superscan 4 6 Laboratory values, median ALP (U/L) 131 133 PSA (ng/mL) 33 59 Prior abiraterone, % 40 48 Prior docetaxel, % 16 39 Prior Sipuleucel-T, % 18 9 Conclusions In this subgroup of pts treated with combined ENZ/RAD in a real-world setting, there was no new safety signal...Pts received ENZ/RAD earlier in the disease course based on time from mCRPC, time from initial diagnosis of bone metastases and prior docetaxel. Fracture incidence was low in ENZ/RAD, and the majority of pts..."

Clinical • Metastases • Castration-Resistant Prostate Cancer • Genito-urinary Cancer • Oncology • Prostate Cancer • Solid Tumor

Radium 223 without androgen deprivation therapy (ADT) in patients (Pts) with biochemically recurrent prostate cancer (BCR) and PET findings in the bones. (ASCO-GU 2026) - P2 | "Radium-223 in BCR is safe and associated with minimal grade 1/2 toxicities. Decreases in SUVmax seen on most NaF scans suggest Radium-223 targeting of suspicious lesions. Improvements in PSMA imaging have been observed."

Clinical • Genito-urinary Cancer • Oncology • Prostate Cancer • Solid Tumor

Open-label, multicentre randomised trial of Radium223-docetaxel versus docetaxel-Radium223 sequence in metastatic castration resistant prostate cancer (mCRPC) with prospective biomarker evaluation (RAPSON study) (ESMO 2024) - P2 | "Background: Defining the most effective treatment sequence between α emitter Radium223 and docetaxel is pivotal for optimizing bone-dominant mCRPC outcomes. RAPSON is a prospective, multicentre, randomized phase 2 trial in 70 patients (pts) with symptomatic bone-dominant mCRPC who progressed after androgen deprivation therapy ± abiraterone or enzalutamide. RAPSON trial provided evidence to support the use of Radium223 prior to chemotherapy in bone-dominant symptomatic mCRPC with a clinical benefit in terms of better QoL and tolerability."

Biomarker • Clinical • Late-breaking abstract • Metastases • Genito-urinary Cancer • Metastatic Castration-Resistant Prostate Cancer • Oncology • Prostate Cancer • Solid Tumor

A multicenter, randomized, phase 2, investigator-initiated ETCTN trial of olaparib + radium-223 vs. radium-223 in men with castration-resistant prostate cancer (CRPC) with bone metastases (BM) (COMRADE): Initial efficacy and biomarker analysis. (ASCO 2025) - P1/2 | " Patients were randomized 1:1 to olaparib + radium-223 (Arm A) vs. radium-223 (Arm B), stratified by prior docetaxel and BM extent (≤20/>20). In this phase 2, multicenter trial, olaparib + radium-223 demonstrated superior rPFS to radium-223, in both HRR+ and HRR- groups, with manageable side effect profile in CRPC patients with BM. Tissue and serial ctDNA analyses are underway and will be presented."

Biomarker • Clinical • P2 data • Anemia • Castration-Resistant Prostate Cancer • Genito-urinary Cancer • Oncology • Prostate Cancer • Solid Tumor • BRCA1 • BRCA2 • HRD

[VIRTUAL] Randomized phase II study evaluating the addition of pembrolizumab to radium-223 in metastatic castration-resistant prostate cancer. (ASCO-GU 2021) - P2 | "In the 62% of treated pts with evaluable paired bx at baseline and after 8 wks, there was no evidence of increased CD4+ or CD8+ T-cell infiltration with R223 + pem. Additional biomarker analyses will be presented. This study revealed that R233 + pem did not result in unexpected AEs, but did not lead to prolonged rPFS or OS compared to R223 alone to support this two-drug combination in a biomarker-unselected population in this setting."

Clinical • IO biomarker • P2 data • Genito-urinary Cancer • Oncology • Prostate Cancer • Solid Tumor • CD4 • CD8

Rad2Nivo: Phase IB study of radium-223 (Rad) with nivolumab (Nivo) in patients (pts) with metastatic castration-resistant prostate cancer (mCRPC). (ASCO 2026) - P1 | "The study met its primary endpoints. Rad+Nivo appears to be safe and VAF was decreased in 60% of patients tested. Survival outcomes and clinical correlation data with VAF will be presented at the meeting."

Clinical • IO biomarker • Metastases • P1 data • Castration-Resistant Prostate Cancer • Genito-urinary Cancer • Oncology • Prostate Cancer • Solid Tumor

A phase 2 randomized trial of radium-223 dichloride and cabozantinib in patients (pts) with renal cell carcinoma (RCC) with bone metastases (BM): RADICAL (Alliance A031801). (ASCO 2026) - P2 | "Radium-223 did not improve the primary endpoint of SSE-FS when added to cabozantinib but a numerical prolongation in OS was observed. Combination treatment was safe. Alternative radiotherapeutics warrant investigation in RCC."

Clinical • P2 data • Genito-urinary Cancer • Oncology • Prostate Cancer • Renal Cell Carcinoma • Solid Tumor

No, There is No Role for Radium-223 at Present (EANM 2026) - No abstract available

Outcomes of Radium-223 and Stereotactic Ablative Radiotherapy Versus Stereotactic Ablative Radiotherapy for Oligometastatic Prostate Cancers: The RAVENS Phase II Randomized Trial. (PubMed, J Clin Oncol) - "Adding Ra223 to SABR MDT in BM omCSPC does not delay progression of disease. We provide evidence for an HiRi mutational signature and TCR repertoire as prognostic biomarkers in omCSPC treated with SABR MDT, highlighting the importance of collecting biological correlates in RCTs for omCSPC."

Clinical • IO biomarker • Journal • P2 data • Genito-urinary Cancer • Hormone Sensitive Prostate Cancer • Oncology • Prostate Cancer • Solid Tumor • BRCA1 • BRCA2 • RB1 • TP53

Radium-223 therapy in metastatic castration-resistant prostate cancer: baseline predictors of treatment completion and survival in a reimbursement-regulated Taiwanese cohort. (PubMed, Ann Nucl Med) - "In a symptomatic, reimbursement-regulated mCRPC cohort, baseline ALP and Hb are associated with Ra-223 completion, whereas survival is associated with tumor activity (ALP, PSA), marrow reserve (Hb), and prior systemic therapy. The classification provides prognostic stratification within a Ra-223-treated population but does not establish treatment-specific benefit and requires external validation."

Journal • Reimbursement • US reimbursement • Castration-Resistant Prostate Cancer • Genito-urinary Cancer • Oncology • Prostate Cancer • Solid Tumor

A potential biomarker of radiosensitivity in metastatic hormone sensitive prostate cancer patients treated with combination external beam radiotherapy and radium-223. (PubMed, Radiother Oncol) - "While some patients responded to this combination treatment, others relapsed within one year of treatment initiation. This study identifies a biomarker based approach that may be useful in predicting which patients will respond to treatment, by monitoring both increases in DNA damage above baseline levels in circulating lymphocytes and decreases in red blood cell and hemoglobin counts during treatment. All data generated and analyzed during this study are included in this published article."

Biomarker • Journal • Metastases • Genito-urinary Cancer • Hematological Disorders • Oncology • Prostate Cancer • Solid Tumor

Final overall survival results from the EORTC 1333/PEACE-3 trial: Enzalutamide with or without radium-223 in metastatic castration-resistant prostate cancer. (ASCO-GU 2026) - P3 | "The final results of EORTC1333/PEACE-3 confirm that adding six cycles of radium-223 to enzalutamide significantly prolongs overall survival in men with bone-dominant mCRPC, supporting the synergistic potential of this combination. Detailed analyses of efficacy, safety, and subgroups will be presented."

Clinical • Metastases • Castration-Resistant Prostate Cancer • Genito-urinary Cancer • Oncology • Prostate Cancer • Solid Tumor

Mature phase 1 follow up of alpha emitter 225Ac-J591 with 177Lu-PSMA-I&T in advanced prostate cancer. (ASCO-GU 2025) - P1/2 | "Here, we present mature follow up of a phase 1 dose-escalation trial of 225Ac-J591 plus 177Lu-PSMA-I&T (aka PNT2002)...Previous therapies: 11 (61%) with >1 ARPI, 12 (67%) chemo, 5 (28%) sip-T, 3 (17%) radium-223... The combination of PSMA-targeted alpha (via antibody) plus beta (via small molecule) was feasible. High grade AEs were rare and no new safety signals emerged with longer term follow up. Nearly all patients had PSA decline, and 5 had durable disease control off therapy."

Metastases • P1 data • Castration-Resistant Prostate Cancer • Genito-urinary Cancer • Oncology • Prostate Cancer • Solid Tumor