I typically offer R-223 to men after chemotherapy with docetaxel. So it’s in that treatment space where you’re trying to decide between cabazitaxel and radium. These are largely men whose disease has progressed on either abiraterone or enzalutamide and sipuleucel-T (sip-T).

R-223 is administered by a nuclear medicine physician at my institution, but the patients are followed by a medical oncologist every month. The nuclear medicine physician checks the labs to make sure it’s safe to administer, but they’re not following the patients long term.

When I have a patient who I want to get started on radium, it typically takes 1 to 2 weeks from referral for them to get started on treatment. I follow patients once per month. R-223 doesn’t cause organ damage, liver or kidney problems. But we do check CBC with differential every month.

I typically integrate R-223 after docetaxel chemotherapy for patients with bone metastasis-only disease.

In my institution, nuclear medicine personnel administer R-223 to the patient. I follow patients on R-223 once a month.

I have administered R-223 to 2 patients off study who had late-stage disease. They had received docetaxel, cabazitaxel and enzalutamide and had exhausted other treatment options. I would consider R-223 typically alone, following chemotherapy, for patients who had bone-predominant disease. We do not have much data about the safety of chemotherapy after R-223. I would be concerned that R-223 may impair future bone marrow tolerance to chemotherapy.

In my institution, the nuclear medicine physician would administer the R-223. I always see patients the week before each administration, so I am following them once a month.

We tend to use R-223 as a standard for patients who have much more extensive bony involvement after other treatments. Our local culture here is that if someone has a few isolated metastases and they’re together and they’re problematic and symptomatic, we tend to do focal irradiation. If the metastasis is much more extensive, we tend to save the radium as an extra salvage therapy — for example, in patients who have experienced disease progression on another primary metastatic CRPC therapy. I believe that’s more likely how it’s been used around here, in combination with something such as abiraterone or enzalutamide.

At our institution, it’s the radiation oncologists who administer it. I see them for follow-up pretty far along in their course after they’ve received the R-223.

I’d rather use R-223 earlier in the course of the disease than later. It’s hard to say second line or third line because it makes a difference what they’ve had previously. If a patient is castration resistant and receives sip-T followed by enzalutamide and now I’m going to administer radium, it is difficult to determine what line that is. If I have a patient with disease outside the bone, because radium is only a bone-targeted agent, I may use it with abiraterone or enzalutamide. I do not use it with chemotherapy at this point because it’s too dangerous to do outside of a clinical trial.

At our institution, nuclear medicine personnel administer R-223 and we work closely with them. We set up joint guidelines, and we communicate with them when we’re sending a patient and so on. We follow patients once a month for 6 consecutive months. We usually see them either at the time they’re about ready to receive their next radium infusion or, if they fared well with the first and second one and everything else is equal, we may let them go for 2 or 3 months. But I would say, on average, we’re seeing them about every other infusion.

It depends on the patient, but it’s generally after the secondary hormonal therapies. I believe more often I use it before chemotherapy than after chemotherapy.

At my institution, nuclear medicine personnel administer R-223 and we work closely with them. I follow patients once a month. In my experience, the majority of patients receive 6 cycles. I would say that about 25% of my patients discontinue R-223 therapy.

We’re using R-223 either pre- or postdocetaxel, depending on the patient. We’re about to open a randomized Phase II trial of R-223 in combination with either abiraterone or enzalutamide versus R-223 alone for patients who’ve not received any of those agents.

Nuclear medicine personnel administer R-223 at my institution. I usually see the patient monthly for follow-up. We look for myelosuppression, particularly anemia. That’s pretty much all we look for.

I administer R-223 in combination with second-line hormonal therapy such as abiraterone and enzalutamide for patients with bone-dominant disease.

At our institution, radiation oncologists administer R-223 and we work closely with them.

In my experience with patients in the prechemotherapy population, I do recommend the use of R-223, and often it is being administered concomitant to abiraterone or enzalutamide.

Our radiation oncology colleagues administer the R-223. We work closely with them. Our lab will usually do CBC monitoring within one week. I usually see these patients every 2 months while they are receiving their course of R-223.