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A combination therapy of **radium-223 dichloride**, an alpha-emitting radiopharmaceutical, and **pembrolizumab**, a programmed death-1 (PD-1) immune checkpoint inhibitor monoclonal antibody. Radium-223 selectively targets bone metastases with high-energy, short-range alpha-particles causing double-stranded DNA breaks in adjacent tumor cells, approved for metastatic castration-resistant prostate cancer (mCRPC) with symptomatic bone metastases and no known visceral metastatic disease. Pembrolizumab blocks PD-1, restoring T-cell–mediated antitumor immunity. The combination has been investigated in phase II trials for mCRPC to bone, with studies showing that pembrolizumab addition does not significantly enhance immune infiltration or clinical outcomes beyond radium-223 alone, but the regimen is generally well tolerated[1][3][5][7][9].
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