803TiP - ERA 223-A phase 3 trial of radium-223 dichloride (Ra-223) in combination with abiraterone acetate (AA) and prednisone in the treatment of asymptoma...

Date 27 September 2014
Event ESMO 2014
Session Poster Display session
Topics Anticancer Agents
Supportive Measures
Prostate Cancer
Biological Therapy
Presenter Matthew Smith
Citation Annals of Oncology (2014) 25 (suppl_4): iv255-iv279. 10.1093/annonc/mdu336
Authors M.R. Smith1, C. Parker2, B. Tombal3, K. Miller4, F. Saad5, F. Fang6, A. Zhang7, M. Kornacker8, C. Higano9
  • 1Hematology-oncology, Massachusetts General Hospital Cancer Center, 02114 - Boston/US
  • 2Academic Urology, The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Sutton/GB
  • 3Division Of Urology, Cliniques Universitaires Saint-Luc, 1200 - Brussels/BE
  • 4Department Of Urology, Charité Berlin, Berlin/DE
  • 5Surgery/urology, University of Montreal Hospital Center, H2L4M1 - Montreal/CA
  • 6Global Clinical Statistics, Bayer HealthCare, Whippany/US
  • 7Oncology, Bayer HealthCare, Whippany/US
  • 8Clinical Development Oncology Ii, Bayer Pharma AG, Berlin/DE
  • 9Medical Oncology, University of Washington, 98109 - Seattle/US



Ra-223, a first-in-class alpha-radiopharmaceutical targeting bone metastases (mets), reduced risk of death by 30% and delayed time to first symptomatic skeletal event (SSE) versus placebo (15.6 vs 9.8 mo; HR = 0.66) in the phase 3 ALSYMPCA trial (Parker et al. NEJM 2013). Ra-223 has favorable safety, and the lack of significant toxicity supports combining Ra-223 with other agents. AA improved radiologic progression-free survival (rPFS) and overall survival (OS) (Ryan et al. NEJM 2012), and its safety profile indicates no overlapping toxicity with Ra-223. This study investigates the efficacy and safety of Ra-223 plus AA versus AA alone in chemotherapy-naïve patients (pts) with bone-metastatic CRPC.

Trial design

This phase 3, double-blind, placebo-controlled, multinational trial (ERA 223, NCT02043678) will randomize approximately 800 pts with asymptomatic or mildly symptomatic, chemotherapy-naïve, bone-predominant metastatic CRPC 1:1 to receive Ra-223 (50 kBq/kg IV) every 4 weeks for 6 cycles or matching placebo plus AA (oral 1000 mg daily) and prednisone (oral 5 mg twice daily), followed by AA plus prednisone thereafter until an SSE or death occurs. Randomization is stratified by geographic region, concurrent use of denosumab or bisphosphonates, and total alkaline phosphatase. The primary end point is SSE-free survival. Secondary end points include OS, time to opiate use for cancer pain, time to pain progression, time to cytotoxic chemotherapy, rPFS, and acute and long-term safety. All pts are assessed at each treatment visit for efficacy, safety, and health-related quality of life, and every 3 months for progression and long-term safety. Pts who complete all study treatment and do not have an SSE enter an active follow-up period. Long-term follow-up begins after pts experience an SSE and ends 7 years after the last dose of Ra-223 or at death, loss to follow-up, or withdrawal. This trial is currently recruiting pts.


M.R. Smith: has had a consultancy relationship with Bayer; C. Parker: has had a consultant or advisory relationship with Algeta, Bayer, and BNIT, and has received honoraria from Amgen, Astellas, Bayer, Janssen, Sanofi-Aventis, and Takeda; B. Tombal: has had a consultant or advisory relationship with and has received honoraria from Bayer and Janssen; K. Miller: has had a consultant or advisory relationship with and has received honoraria from Astellas, Janssen, Bayer, Novartis, Amgen, Merck, and BMS; F. Saad: has had a consultancy relationship with and has received research funding and honoraria from Bayer; F. Fang: is employed by and has an ownership interest in Bayer HealthCare; A. Zhang: is employed by Bayer HealthCare; M. Kornacker: is employed by and has an ownership interest in Bayer Pharma AG; C. Higano: has had a consultancy relationship with Bayer and Johnson & Johnson and has received research funding from Algeta, Bayer, and Janssen.