Australian Government - Department of Health and Ageing

Medical Services Advisory Committee (MSAC)

1268 - The use of Radium-223, for the treatment of patients with symptomatic hormone refractory prostate cancer with skeletal metastases

Assessment No

1268
Application NameRadium-223 for the treatment of patients with symptomatic hormone refractory prostate cancer with skeletal metastases
Assessment TypeSubmission based assessment
Description Of Medical ServiceRadium 223, which is an injection, is an alpha emitting pharmaceutical (alpha-pharmaceutical). This product naturally targets bone metastases due to its calcium-mimicking properties. The bone targeting property of radium-223 is similar to that of other earth alkaline elements, like strontium-89. However, the radiation characteristics of an alpha-particle emitting radionuclide seem to be more advantageous than a beta-emitting radionuclide. Radium-223, with a physical half-life of 11.4 days, emits high linear energy transfer alpha radiation, with a range limited to less than 100 micrometers, and can thus be used to generate localised radiation zones. An alpha-emitting radiation source located in a target tissue, such as skeletal metastases, will deliver the radiation to a more localised volume, thereby reducing exposure of surrounding normal tissues.
Description Of Medical ConditionProstate cancer cell growth is stimulated by male hormones (androgens), in particular testosterone and its metabolite dihydro-testosterone. Therefore, patients may be treated by androgen deprivation to reduce levels of male hormones available to cancer cells. Androgen deprivation can be achieved surgically (castration), or medically using hormone therapy.

Unfortunately, patients ultimately stop responding to hormone therapy and are then referred to as having hormone-refractory or androgen-independent prostate cancer.

The most common site of cancer spread in men with hormone refractory prostate cancer is bone. Development of bone metastases is a major problem in prostate cancer and is a serious threat to a patient’s survival and quality of life. Untreated patients face severe morbidity, including bone pain, bone fracture, compression of the spinal cord and haematological consequences of bone marrow involvement. If treated successfully, these symptoms may be palliated and patients may also gain a survival benefit.
Pre Assessment Meeting7 December 2011
Stage 2 – Suitability for Assessment11 January 2012
Proposed DAP Received12 January 2012
Stage 3 - 1st PASC
(Draft DAP considered)
12-13 April 2012
Stage 3 – Release for Public Comment
(Consultation DAP)
28 May - 5 July 2012
Consultation Decision Analytic Protocol (DAP) - PDF
Consultation Decision Analytic Protocol (DAP) - Accessible Word version
Stage 3 - 2nd PASC
(Final DAP)
16-17 August 2012
Final Decision Analytic Protocol (DAP) - PDF
Final Decision Analytic Protocol (DAP) - Accessible Word version
Stage 4 - Submission of Collated EvidenceTo be advised by Applicant
Stage 5 - ESC evaluation
Stage 6 - MSAC Appraisal
Stage 6 - MSAC advice
Stage 7 - Noting by Minister
Stage 8 - Implementation

Page currency, Latest update: 03 May, 2013

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