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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5) What about OS and ORR?
Median OS was 28.3 vs 19.7 months (HR 1.40; 95% CI, 0.70–2.79).
Confirmed ORR was 19.4% vs 25.0%.
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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.
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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.
Jul 27, 2026 · 11:18 PM UTC
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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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