More than 90% of patients with prostate cancer are candidates for orchiectomy due to the development of metastatic disease affecting bone tissue. Patients with bone metastases may suffer from pathological fractures, uncontrolled pain syndrome, spinal cord compression, and other manifestations of the disease that require surgical intervention or radiation therapy. These manifestations of disease progression significantly worsen the quality of life and increase the costs of patient care.
Until recently, therapy for patients with bone metastases was palliative, and the effectiveness of bisphosphonates and Denosumab was limited to merely delaying the development of bone metastases without significant improvement.
Currently, there is a need for more effective therapy for bone metastases that can extend the lifespan of patients undergoing palliative treatment, which is accompanied by side effects.
The drug "Xofigo" (radium-223 dichloride) is a targeted therapy for metastatic lesions in bone tissue, destroying these focal lesions through alpha radiation. Due to the unique properties of mass and charge, alpha particles release high energy over an extremely short distance (less than 100 microns) – this characteristic makes them less permeable to the surrounding environment (thus, there is less damage to the healthy bone marrow tissue near metastatic foci, resulting in significantly fewer side effects for the patient). This therapy is more toxic to metastatic lesions compared to gamma or beta radiation.
In a randomized international study ALSYMPCA, overall survival considering side effects was compared between therapy with "Xofigo" and a group of patients receiving placebo. The study was conducted in patients suffering from castration-resistant prostate cancer with symptomatic bone metastases. The study was terminated early due to compelling evidence of the advantage of "Xofigo", which increased patient survival (the median overall survival was 14.9 compared to 11.3 months). Patients receiving "Xofigo" experienced significantly fewer recurrences of metastatic spread to bone tissue. In patients with pre-existing metastatic bone lesions, the median time to the first recurrence was significantly longer (13.6 months compared to 8.4 months). Additionally, therapy with "Xofigo" proved to be the safest. The manifestation and occurrence of side effects were less pronounced compared to the group of patients receiving placebo (an unusual phenomenon in oncology studies). Furthermore, therapy with "Xofigo" is characterized by a low incidence of bone marrow suppression.
The ongoing study represents a promising breakthrough in the treatment of patients with metastatic castration-resistant prostate cancer. Alpha radiation has a completely different mechanism of action compared to previously provided medications (hormonal or chemotherapy agents). The drug "Xofigo" has the least pronounced side effects compared to other drugs. Therefore, it can be used by many patients who, due to their health condition, were previously unable to receive standard therapy (for example, chemotherapy, which is accompanied by multiple side effects).
There are numerous studies and programs through which patients with metastatic castration-resistant prostate cancer receive the drug "Xofigo". Additionally, many patients undergo standard therapy regimens. Patients experience numerous clinical benefits, including reduced pain syndrome and significant improvement in quality of life at home and at work. Imaging study results demonstrate improvement or stabilization of disease in patients who had disease progression prior to therapy. These results were predominantly achieved with virtually no side effects!