1)🚨 Results from #RADICAL (#A031801) are now published in @JCO_ASCO, led by @DrRanaMcKay and @ALLIANCE_org
A THREAD!
Bone metastases occur in ~30% of patients with metastatic #RCC and are associated with increased skeletal morbidity and worse survival.
RADICAL trial evaluated whether adding radium-223, an α-emitting bone-seeking radiopharmaceutical, to VEGF TKI Cabozantinib could improve outcomes in patients with metastatic RCC + bone metastases
Link: ascopubs.org/doi/10.1200/JCO…
@OncoAlert @OncBrothers @AUC3_Official @Uromigos @ASCO
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4) RESULTS
Median follow-up was 13.1 months.
Primary Endpoint NOT MET
Median SSEFS:
• 16.7 months with cabozantinib + radium-223
• 17.6 months with cabozantinib alone
HR 1.46 (90% CI, 0.86–2.51).
No subgroup demonstrated a consistent benefit with the addition of radium-223...
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6) Safety remained manageable.
Grade ≥3 adverse events occurred in 69.6% of patients receiving cabozantinib + radium-223 and 75.5% receiving cabozantinib alone.
Hematologic toxicities, including anemia, lymphopenia, neutropenia, and thrombocytopenia, were more frequent with the combination, while cabozantinib dose modifications occurred at similar rates across both treatment arms.
Jul 27, 2026 · 11:18 PM UTC
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7) In conclusion, the addition of radium-223 to cabozantinib did not improve symptomatic skeletal event-free survival in patients with metastatic RCC and bone metastases.
Importantly, symptomatic skeletal event rates were lower than anticipated, likely reflecting contemporary management, including routine osteoclast-targeted therapy and earlier palliative radiation.
Although these findings do not support the addition of radium-223 to cabozantinib, they provide important insights that should inform the design of future bone-targeted therapeutic strategies for patients with metastatic RCC.
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8) This study is the culmination of a 10+year work with @DrRanaMcKay, now @UCSDCancer
It all started with a conversation back in 2013, when Rana was a junior attending, pregnant with her 2nd child, and passionately discussing one of the biggest unmet needs in kidney cancer; patients with bone metastases, who consistently had poor outcomes despite available systemic therapies.
That conversation sparked a decade of work dedicated to understanding the biology of bone metastases.
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10) The Body of work:
• 2013: pubmed.ncbi.nlm.nih.gov/2396…
• 2014: pmc.ncbi.nlm.nih.gov/article…
• 2018 (METEOR): pubmed.ncbi.nlm.nih.gov/2930…
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11) More context
2018 (Pilot Study): study in @AACR CCR of Radium-223 + pazopanib (1st line mRCC) or Sorafenib (2nd line RCC)
aacrjournals.org/clincancerr…
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12) what a journey! Hats off to the tenacity of @DrRanaMcKay + @ALLIANCE_org and everyone along the way, especially our patients and their families. Fin...
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