![]() Xofigo increased overall survival, along with time to first symptomatic skeletal event (15.6 months vs. Radium-223 is a targeted alpha-particle-emitting agent that preferentially binds to the newly formed bone matrix, such as in metastatic bone lesions, causing cytotoxic dsDNA breaks to those targeted cells. Radium-223, or Xofigo (Bayer Pharmaceuticals Inc., Whippany, NJ), was approved by the FDA for use in 2013 for CRPC in patients with symptomatic bone metastases in the absence of visceral involvement after the phase III ALpharadin in SYMPtomatic Prostate CAncer (ALSYMPCA) trial. Current treatment of metastatic CRPC (mCRPC) can include anti-androgens (abiraterone, enzalutamide), taxane-based chemotherapy, immunotherapy (sipuleucel-T, pembrolizumab), and radiation. Castration-resistant prostate cancer (CRPC) is defined by the progression of disease despite treatment with androgen deprivation therapy (ADT), 90% of which ultimately proceeds to have bone metastases. Prostate cancer is the second leading cause of cancer-related deaths in men in the United States. Factors such as age, functional status, and prior radiation therapy have to be considered prior to Xofigo treatment. We found a higher rate of Xofigo-induced pancytopenia in our patient population than the 2% reported in the literature, albeit with a limited sample size, This may influence clinical decision making in the treatment of mCRPC, as pancytopenia may preclude patients from other survival-prolonging therapies. In addition, a higher percentage of patients who received prior radiation therapy were more likely to develop pancytopenia (90% vs 75%). Older age and higher ECOG score correlated with increased risk of pancytopenia. Ten patients (45%) developed pancytopenia, with two recovering counts within eight months while the other eight had persistent cytopenias (six of which were transfusion-dependent). Sixteen patients (73%) completed the full course (six doses) of Xofigo, while six did not. Twenty-three patients received Xofigo at UF Health, and one was lost to follow-up. Data collected included complete blood count (CBC), ECOG (Eastern Cooperative Oncology Group) functional status, kidney and liver function, evidence of bony disease on imaging, prior chemotherapy regimens, total radiation dose, and prostate-specific antigen (PSA). MethodsĪ retrospective analysis was performed by analyzing patients with mCRPC who received Xofigo at the University of Florida Health Shands Hospital (UF Health Shands) in a three-year span. However, the incidence seen in our institutional clinical practice is higher than that reported in the literature. Hematologic side effects of radium-223 included all-grade anemia in 31% of the patients, thrombocytopenia in 12%, and neutropenia in 5%, and persistent pancytopenia noted in 2%. Radium-223 (Xofigo, Bayer Pharmaceuticals Inc., Whippany, NJ) has been shown to increase overall survival in patients with metastatic castration-resistant prostate cancer (mCRPC), via the phase 3 ALpharadin in SYMPtomatic Prostate CAncer (ASLYMPCA) study.
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