Xofigo
Xofigo (radium Ra 223 dichloride) is a radiopharmaceutical used to treat prostate cancer that’s spread (metastasized) only to the bones and is causing symptoms like pain or fractures. It’s given as a quick injection through the vein at treatment centers with staff trained to safely handle medications containing radiation. After each Xofigo (radium Ra 223 dichloride) injection, it's important to handle your bodily waste (e.g., urine, feces, vomit) with care for one week to reduce the risk of exposing others to radiation. Common side effects are low blood cell counts, nausea, and diarrhea.
What is Xofigo (radium Ra 223 dichloride)?
What is Xofigo (radium Ra 223 dichloride) used for?
Metastatic, castration-resistant prostate cancer that’s spread to the bone only and causing symptoms
How Xofigo (radium Ra 223 dichloride) works
Xofigo (radium Ra 223 dichloride) is a radiopharmaceutical. It’s made of the radioactive chemical radium-223. Radium-223 acts like calcium in the body and is taken into the bones.
Advanced prostate cancer can sometimes spread to the bones. So when Xofigo (radium Ra 223 dichloride) is absorbed into the bone, the radioactivity damages the tumor cells there, stopping them from growing and spreading.
Drug Facts
What are the side effects of Xofigo (radium Ra 223 dichloride)?
Common Side Effects
- Low red blood cell counts (93%)
- Low white blood cells (up to 72%)
- Nausea (36%)
- Low platelet count (31%)
- Diarrhea (25%)
Other Side Effects
- Vomiting
- Swelling in the arms and legs
Serious Side Effects
- Low blood cell counts: fever, chills, feeling very tired, dizziness, unusual bleeding or bruising
Source: DailyMed
The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Infection—fever, chills, cough, sore throat, wounds that don't heal, pain or trouble when passing urine, general feeling of discomfort or being unwell
- Unusual bruising or bleeding
Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):
Pros and cons of Xofigo (radium Ra 223 dichloride)
Pros
Recommended option for prostate cancer that’s only spread to the bones
Works by specifically targeting prostate cancer cells in the bone
Treatment given once every 4 weeks for 6 doses
Cons
Radioactive treatment, so extra safety precautions are needed during and after treatment
Only given in specific treatment centers with staff trained to handle radiation
Often causes low blood cell counts, nausea, and diarrhea
Pharmacist tips for Xofigo (radium Ra 223 dichloride)
Xofigo (radium Ra 223 dichloride) is a radiation treatment. You’ll likely receive treatment from staff trained in handling this type of medication. You will receive instructions on radiation safety for when you leave the clinic.
For at least the first week after receiving Xofigo (radium Ra 223 dichloride), you’ll need to handle bodily waste (e.g., urine, feces, vomit) carefully. If any bodily waste spills, make sure to clean up the waste promptly and use disposable gloves when cleaning. If the waste gets on clothing, wash those items separately.
Practice good hygiene when using the bathroom. For at least the first week after your Xofigo (radium Ra 223 dichloride) treatment, flush the toilet multiple times after using it, and wash your hands well to avoid radiation exposure to others.
Drink plenty of water throughout the days before and after your Xofigo (radium Ra 223 dichloride) treatment. This helps prevent potential kidney damage from the radiation. Let your treatment team know if you’re feeling dehydrated, or have any new or worsening problems urinating.
Xofigo (radium Ra 223 dichloride) can lower blood cell counts, which can raise your risk for infection. It’s a good idea to wash your hands often and avoid people who are sick. Notify your treatment team if you have signs of an infection, like a fever or chills.
Xofigo (radium Ra 223 dichloride) can harm unborn babies. Use condoms, and if you have a partner who could become pregnant, make sure they use effective contraception during and for 6 months after the last dose.
Xofigo (radium Ra 223 dichloride) might cause infertility. This is because radiation can be absorbed by your testes. Let your provider know if you’re planning on having a child.
If you’ve been receiving certain hormone therapy like leuprolide (Lupron) for your prostate cancer, you might need to continue that treatment along with Xofigo (radium Ra 223 dichloride).
Frequently asked questions about Xofigo (radium Ra 223 dichloride)
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What are the risks and warnings for Xofigo (radium Ra 223 dichloride)?
Xofigo (radium Ra 223 dichloride) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Low blood cell counts (bone marrow suppression)
Xofigo (radium Ra 223 dichloride) affects your bone marrow and causes your body to make fewer blood cells. Low amounts of blood cells can raise your chance of bleeding and make you more likely to get infections. Your provider will have you do blood tests before each dose to make sure the medication is safe to take. Talk to your healthcare provider right away if you suddenly have unusual bleeding or bruising, tiredness, trouble breathing, or develop a fever.
Risk of broken bones when used with certain prostate cancer medications
Risk factors: Taking Xofigo (radium Ra 223 dichloride) with abiraterone (Zytiga) and prednisone or prednisolone
In studies, people who received Xofigo (radium Ra 223 dichloride) together with abiraterone (Zytiga) and certain steroids (e.g. prednisone or prednisolone) had a higher than expected rate of fractures and deaths. Talk with your provider about your prostate cancer treatment plan before starting Xofigo (radium Ra 223 dichloride).
Harm to the unborn baby
Xofigo (radium Ra 223 dichloride) can harm unborn babies. Use of effective birth control, like condoms, while taking this medication and for at least 6 months after your last dose. Also, if your partner is capable of becoming pregnant, it's important for them to also use birth control while you're on this medication and for at least 6 months after your last dose to prevent pregnancy.
Xofigo (radium Ra 223 dichloride) dosage forms
Typical dosing for Xofigo (radium Ra 223 dichloride)
Your treatment team will calculate your specific dose based on your body weight. The typical dose is 55 kBq/kg given as an infusion through the vein (IV) every 4 weeks for 6 doses.
Note: kBq is a unit of radioactivity. Since this medication works by delivering radiation, the dose is described using units that measure radioactivity.
What are alternatives to Xofigo (radium Ra 223 dichloride)?
Metastatic, castration-resistant prostate cancer that’s spread to the bone only and causing symptoms
Cancer that needs testosterone to grow (Zytiga only)
Cancer that can still grow when there’s not much testosterone (Yonsa and Zytiga)
Xofigo (radium Ra 223 dichloride) images
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References
Best studies we foundAmerican Cancer Society. (2023). Treatments for prostate cancer spread to bones.
Bayer HealthCare Pharmaceuticals Inc. (2019). Xofigo- radium ra 223 dichloride injection [package insert]. DailyMed.
Gupta, N., et al. (2017). Usefulness of radium-223 in patients with bone metastases. Baylor University Medical Center Proceedings.
National Cancer Institute. (2020). Radiopharmaceuticals: Radiation therapy enters the molecular age.
National Comprehensive Cancer Network. (2022). Advanced-stage prostate cancer.
Parker, C., et al. (2013). Alpha emitter radium-223 and survival in metastatic prostate cancer. The New England Journal of Medicine.
Sartor, O., et al. (2014). Effect of radium-223 dichloride on symptomatic skeletal events in patients with castration-resistant prostate cancer and bone metastases: Results from a phase 3, double-blind, randomised trial. The Lancet Oncology.
United States Nuclear Regulatory Commission. (2021). Becquerel (Bq).
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