Radioligand Therapy for Bone Metastases

How Does Xofigo Therapy Work?

Therapy with the active substance Xofigo is a so-called targeted radionuclide therapy that can be used for patients with advanced prostate cancer and bone metastases. The radioactive drug radium-223-dichloride, which has the trade name Xofigo, is used for this purpose.

Radium is a so-called calcium analog, which, like calcium, accumulates within the bones and can irradiate the bone metastases in this way. It penetrates the tumor cells and destroys them from the inside. Since radium belongs to the so-called alpha emitters, which have a low radiation range, the drug shows little effect on the surrounding tissue.

For Which Patients Is Radioligand Therapy Suitable?

Patients with advanced prostate cancer and pain due to bone metastases can receive current therapy. However, the treatment can only be considered if cancer has not yet spread to other organs.

Bone metastases are verified before therapy is started using a technique called skeletal scintigraphy and diagnostic radiology. Imaging techniques are also used to exclude metastases in the organs. In addition, the patient must have a sufficiently stable blood count since the therapy can affect the formation of the blood cell series in the bone marrow and thus on the blood count.

In addition, the therapy is only considered if the patient has not responded at all or not responded sufficiently to previous therapies and the tumor disease continues to progress. This condition is also called "hormone-refractory" or "castration refractory" prostate cancer, as systemic therapy for prostate cancer usually involves hormone blockade of testosterone. Additionally, therapy with Xofigo may be an option for patients who cannot be given systemic therapy for specific reasons.

Procedure and Duration

Treatment proceeds in three steps. First, patients undergo a preliminary examination with detailed information and imaging procedures to assess the possibility of therapy. Subsequently, patients receive six treatments with the radionuclide at four-week intervals. Finally, the drug is injected into the vein, and the venous access is flushed with saline before and after administration of the agent. The therapy can usually be performed in an outpatient setting. The patient can be discharged immediately after the procedure is completed and will only remain in the hospital for about one to two hours.

What Are the Advantages of Ra-223 Treatment?

The treatment can prolong survival in many patients. In addition, it serves to improve patients' quality of life, as the therapy can reduce bone pain that results from metastases. It can also prevent complications that bone metastases may cause.

What Are the Risks and Side Effects?

In most cases, the therapy is very well tolerated and usually has no acute side effects. However, mild side effects such as nausea, vomiting, and a temporary increase in bone pain may occur following treatment. In addition, the treatment may impact the blood count and lead to a decrease in the number of platelets and white blood cells.

How Much Does the Treatment Cost?

The entire therapy costs between forty and seventy-five thousand euros and is usually covered by health insurance.

What Is the Experience with Xofigo?

Many patients can be given prolonged survival with the therapy. In addition, improved quality of life can be achieved so that experiences with the treatment are often described as very positive. Nevertheless, a cure is not possible through radionuclide therapy with Xofigo. Patients should be informed about this in detail in advance.

Sources:

• https://www.uksh.de/nucmed-kiel/Infos+für+Patienten/Xofigo_Therapie-p-312.html
• https://www.gesundheitsinformation.de/radium-223-dichlorid-xofigo-bei-fortgeschrittenem-prostatakrebs.html
• https://www.luks.ch/sites/default/files/2017-11/Patienteninformation_Xofigo_2016_02_09_stro%20korrneu.pdf
• https://www.medizin.uni-tuebingen.de/de/das-klinikum/einrichtungen/kliniken/radiologie/nuklearmedizin/therapie/xofigo-therapie
• https://www.g-ba.de/downloads/92-975-416/2013-12-13_Modul1_Radium-223-dichlorid_mCRPC.pdf