{"entity":{"id":"radium-223","kind":"drug","name":"Radium-223 dichloride","aka":[],"tldr":"Radium-223 was the first alpha-emitting drug ever approved (2013). It homes to bone like calcium and treats prostate cancer that has spread only to bone.","summary":"Radium-223 is a calcium mimetic incorporated into bone matrix at sites of metastatic bone turnover, where each decay chain delivers four alpha emissions over a range of a few cells, killing tumour while largely sparing marrow. It is given intravenously to men with symptomatic castration-resistant prostate cancer whose spread is confined to bone without visceral disease. ALSYMPCA showed overall survival of 14.9 versus 11.3 months (HR 0.70) and fewer skeletal events, and it became the first alpha-emitting drug ever approved (2013). ERA 223 showed excess fractures when combined with abiraterone, now contraindicated without bone protection, while PEACE III (2024) with enzalutamide plus bone-protecting agents was positive for rPFS and overall survival. How to sequence it with 177Lu-PSMA therapy is unresolved. Simply put, it is a radioactive calcium look-alike that homes to bone metastases.","status":"approved","asOf":"2026-09-06","wikipedia":"https://en.wikipedia.org/wiki/Radium-223","links":[{"label":"FDA label (DailyMed)","url":"https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=Radium-223%20dichloride"},{"label":"NICE TA412: radium-223 dichloride for treating hormone-relapsed prostate cancer with bone metastases","url":"https://www.nice.org.uk/guidance/ta412"},{"label":"PEACE-3 final overall survival (Annals of Oncology 2026)","url":"https://doi.org/10.1016/j.annonc.2026.02.009"}],"tags":[],"related":[],"cancers":["prostate","prostate-mcrpc"],"sections":[],"technologies":["targeted-alpha-therapy"],"targets":[],"drugs":[],"companies":["bayer"],"institutions":[],"pathways":[],"terms":["alpha-vs-beta","prostate-crpc-sequencing","prostate-uk-drug-approvals"],"trials":["alsympca"],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":["NICE TA412 recommends radium-223 dichloride for hormone-relapsed prostate cancer with symptomatic bone metastases and no known visceral metastases, only after docetaxel or where docetaxel is contraindicated or unsuitable, with the patient access scheme discount. Two trials define the combination rules: ERA 223 (abiraterone, no mandatory bone protection) produced fractures in 29 against 11 percent with no benefit, and PEACE-3 (enzalutamide, bone-protecting agents mandatory from March 2018) produced median overall survival 38.2 against 32.6 months, hazard ratio 0.76."],"brand":"Xofigo","modality":"Targeted alpha therapy (bone-seeking)","mechanism":"Calcium mimetic incorporated into bone matrix at metastases; four alpha emissions per decay chain.","approvals":[{"region":"US","year":2013,"indication":"Symptomatic bone-metastatic CRPC without visceral disease"}],"mechanismSteps":[],"toxicity":[],"access":[],"regulatoryEvents":[]},"route":"/drugs/radium-223/","neighbours":{"cancer":[{"id":"metastatic-cancer","kind":"cancer","name":"Metastatic cancer (cancer that has spread)","route":"/cancers/metastatic-cancer/"},{"id":"prostate-mcrpc","kind":"cancer","name":"Metastatic castration-resistant prostate cancer","route":"/cancers/prostate-mcrpc/"},{"id":"osteosarcoma","kind":"cancer","name":"Osteosarcoma","route":"/cancers/osteosarcoma/"},{"id":"prostate","kind":"cancer","name":"Prostate cancer","route":"/cancers/prostate/"}],"technology":[{"id":"bone-modifying-agents","kind":"technology","name":"Bone-modifying agents (bisphosphonates, denosumab)","route":"/technologies/bone-modifying-agents/"},{"id":"pain-management","kind":"technology","name":"Cancer pain management","route":"/technologies/pain-management/"},{"id":"radiopharmaceutical-gmp-release","kind":"technology","name":"Radiopharmaceutical GMP and releasing a drug that decays","route":"/technologies/radiopharmaceutical-gmp-release/"},{"id":"targeted-alpha-therapy","kind":"technology","name":"Targeted alpha therapy","route":"/technologies/targeted-alpha-therapy/"}],"company":[{"id":"bayer","kind":"company","name":"Bayer","route":"/companies/bayer/"}],"term":[{"id":"alpha-vs-beta","kind":"term","name":"Alpha vs beta emitters","route":"/terms/alpha-vs-beta/"},{"id":"bone-metastases","kind":"term","name":"Bone metastases and skeletal-related events","route":"/terms/bone-metastases/"},{"id":"prostate-uk-drug-approvals","kind":"term","name":"Prostate cancer drugs in England: what NICE recommends, and what it refuses","route":"/terms/prostate-uk-drug-approvals/"},{"id":"prostate-crpc-sequencing","kind":"term","name":"What follows what in castration-resistant prostate cancer","route":"/terms/prostate-crpc-sequencing/"}],"trial":[{"id":"alsympca","kind":"trial","name":"ALSYMPCA","route":"/trials/alsympca/"},{"id":"era-223","kind":"trial","name":"ERA 223","route":"/trials/era-223/"},{"id":"peace-3","kind":"trial","name":"PEACE-3 (EORTC 1333)","route":"/trials/peace-3/"}],"idea":[{"id":"idea-prostate-randomise-the-sequence-not-only-the-drugs","kind":"idea","name":"Randomise the order of treatment, not only the drugs: a strategy platform for metastatic prostate cancer","route":"/ideas/idea-prostate-randomise-the-sequence-not-only-the-drugs/"}],"person":[{"id":"karim-fizazi","kind":"person","name":"Karim Fizazi","route":"/people/karim-fizazi/"}],"pathway":[{"id":"organ-tropism-seed-soil","kind":"pathway","name":"Organ tropism: seed and soil","route":"/pathways/organ-tropism-seed-soil/"}],"drug":[{"id":"samarium-153-lexidronam","kind":"drug","name":"Samarium-153 lexidronam","route":"/drugs/samarium-153-lexidronam/"}]}}