My husband is due to start Radium 223 treatments at Stanford. His oncologist wants him to also start XGeva. The XGeva injections were postponed until after he had dental crown work done. He had an appointment for that on 2/6 which has been delayed because he tested + for Covid. His rescheduled appointment is for 2/21. Stanford wants to start the Radium 223 on 2/23. Does anyone have experience or information on the timing of XGeva & Radium? Can he do them at the same time? Will doing that increase the possibility of side effects? Would it be better to wait a week Ti start the Radium?
Sorry I seem desperate. Trying to coordinate all this stuff is really taxing.
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Mcrpca
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Did you read and understand this information? I don't know anything about your situation, how many Mets do you have, what is your current ALP? PSA Etc.
I did read it. Thanks. The bio has his complete history. At this point he has some bone mets with mild to moderate pain, no solid organ mets, PSA was 40 in November and 80 in January. He’s been on Triptorelin (TrelStar 11.25 q 12 weeks) since August. Testosterone is castrate level. We’ve been blessed with 17+ years of remission after prostatectomy with lymph node Mets and 9 months of Casodex & Lupron in 2002. This next treatment is something between a Hail Mary and palliative given his age (80) and his recent Alzheimer’s diagnosis.
It is in a normal range? Could you use SBRT of his Mets if it is feasible? Are they very painful? You could safe up Xofigo for later if he has less than 6 bone Mets. My concern is if the ALP is in a normal range would Xofigo work? Could you ask the referring doctor this question?
We’ve actually researched it pretty thoroughly and this is the best treatment option. I sort of had in my mind a different sequence that got interrupted by Covid🤷🏼♀️. The oncologist says the sequence won’t matter but we live 6 hours away from Stanford (the closest facility that administers Zofigo) so I’m trying to figure the potential side effects into the travel plans. I’m probably WAY overthinking it. 😂
An increased fracture risk was found particularly in patients with a medical history of osteoporosis and in patients with fewer than 6 bone metastases.
In another randomised, double blind, placebo controlled phase III trial (ALSYMPCA), a statistically significant overall survival benefit of treatment with Xofigo could not be demonstrated in the subgroups of patients with fewer than 6 metastases (HR for radium-223 to placebo 0.901; 95% CI [0.553 - 1.466], p=0.674) or a baseline total alkaline phosphatase (ALP) 220 U/L (HR 0.823 95% CI 0.633-1.068, p=0.142), indicating that efficacy may be diminished in patients with a low level of osteoblastic activity from their bone metastases.
Xofigo is not recommended in patients with a low level of osteoblastic bone metastases and in patients with only asymptomatic bone metastases. It is also not recommended in combination with systemic cancer therapies other than LHRH analogues.In mildly symptomatic patients, the benefit of treatment should be carefully assessed against its risks, considering that high osteoblastic activity is likely to be required for treatment benefit (see below for more information).
Before starting and during treatment with Xofigo, an assessment of patients' bone status (e.g. by scintigraphy, bone mineral density measurement) and risk of fractures (e.g. osteoporosis, fewer than 6 bone metastases, medication increasing fracture risk, low body mass index) should be performed. Monitoring should continue for at least 24 months.
In patients with a high baseline risk of fracture, carefully consider the benefit of treatment against the risks.
Concurrent use of bisphosphonates or denosumab has been found to reduce the incidence of fractures in patients treated with Xofigo. Therefore such preventive measures should be considered before starting or resuming treatment with Xofigo.
The Agency's recommendations are based on the assessment of data from a randomised, double blind, placebo controlled phase III trial (ERA-223), which showed that there was an increased incidence of fractures (28.6% vs 11.4%), a possible reduction in median overall survival (30.7 months vs 33.3 months, HR 1.195, 95% confidence interval (CI) 0.950 - 1.505, p=0.13) and an increased risk of radiological non-bone progression (HR 1.376 [95% CIs 0.972, 1.948], p=0.07) among patients receiving Xofigo in combination with abiraterone acetate plus prednisone/prednisolone (n=401) compared to patients receiving placebo in combination with abiraterone acetate plus prednisone/prednisolone (n=405). An increased fracture risk was found particularly in patients with a medical history of osteoporosis and in patients with fewer than 6 bone metastases.
Can you discuss that European paper with your oncologist. If ALP is only 100 you are in a normal range.
Maybe you don't have enough bone activity for the xofigo to be useful.
I personally would try no use SBRT on the painful mats if it is feasible. Can you have an appointment with an RO specialist in SBRT? Some machines are very accurate up to 1mm. I was lucky enough that I have one like that high precision MRI Linac in my neighbourhood.
I appreciate your input but my husband is a doctor and I am a nurse practitioner. We have researched it very thoroughly and this is the best option. He’s been thoroughly scanned and evaluated. I was mostly interested in hearing from individuals who have had both XGeva and Zofigo about their experiences with side effects so I can make helpful travel plans. I’m sorry if I gave you the impression that his treatment plan was open for discussion.
Xofig mimics calcium and if the ALP is low, if there is no bone turnover if his cancer in his bones are not active there will be no benefit from Xofigo.
I am only an electrical engineer interested in biomedical engineering but I am not a doctor.
I still would like to rise my concern with Xofigo.
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