Difference between revisions of "Radium-223 (Xofigo)"

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'''In clinical trials.''' Also known as radium-223 chloride.
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==General information==
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Class/mechanism: Radioactive pharmaceutical agent (radium-223) that mimics some biologic behaviors of calcium and is incorporated into areas with increased bone turnover, such as bone metastases, by forming complexes with hydroxyapatite.  Radium-223 emits alpha radiation at the site of bone metastases, which causes double-strand DNA breaks in nearby cells.  The limited penetration of alpha radiation (less than 100 micrometers/uM, less than 10 cell diameters) is believed to limit the risk of adverse side effects.  Radium-223's half-life is 11.4 daysIts specific activity is 1.9 MBq (51.4 microcurie)/ng; molecular weight of <sup>223</sup>RaCl<sub>2</sub>: 293.9 g/mol.<ref name="insert">[http://labeling.bayerhealthcare.com/html/products/pi/Xofigo_PI.pdf Radium Ra 223 (Xofigo) package insert]</ref><ref>[[:File:Radium223.pdf | Radium Ra 223 (Xofigo)‎ package insert (locally hosted backup)]]</ref><ref>[http://xofigo-us.com/index.php Xofigo manufacturer's website]</ref>
  
==General information==
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Route: IV
Class/mechanism: Radioactive pharmaceutical agent (radium-223) that mimics some biologic behaviors of calcium and is incorporated into bone, where it can release alpha radiation at the site of bone metastases.  The limited penetration of alpha radiation is believed to limit the risk of adverse side effects.  Radium-223's half-life is 11.4 days.<ref>[http://www.algeta.com/dynside.asp?m=34568&s=34659 Alpharadin manufacturer's website]</ref>
 
<br>Route: IV
 
 
<br>Extravasation: no information
 
<br>Extravasation: no information
  
For conciseness and simplicity, HemOnc.org currently will focus on treatment regimens and not list information such as: renal/hepatic dose adjustments, metabolism (including CYP450), excretion, monitoring parameters (although this will be considered for checklists), or manufacturer. Instead, for the most current information, please refer to your preferred pharmacopeias such as [http://www.thomsonhc.com/home/dispatch Micromedex], [http://online.lexi.com/ Lexicomp], [http://www.utdol.com/online/content/search.do UpToDate (courtesy of Lexicomp)], or the prescribing information.
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For conciseness and simplicity, HemOnc.org currently will focus on treatment regimens and not list information such as: renal/hepatic dose adjustments, metabolism (including CYP450), excretion, monitoring parameters (although this will be considered for checklists), or manufacturer. Instead, for the most current information, please refer to your preferred pharmacopeias such as Micromedex, Lexicomp, or the prescribing information.<ref name="insert"></ref>
  
==Clinical trials==
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==Diseases for which it is used==
*Nilsson S, Strang P, Aksnes AK, Franzèn L, Olivier P, Pecking A, Staffurth J, Vasanthan S, Andersson C, Bruland OS. A randomized, dose-response, multicenter phase II study of radium-223 chloride for the palliation of painful bone metastases in patients with castration-resistant prostate cancer. Eur J Cancer. 2012 Mar;48(5):678-86. Epub 2012 Feb 15. [http://www.ncbi.nlm.nih.gov/pubmed/22341993 PubMed]
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*[[Prostate cancer]]
*[http://kundeweb.aggressive.no/users/algeta2.no/filer/parkeralsympca2011.pdf Overall Survival Benefit of Radium-223 Chloride (Alpharadin) in the Treatment of Patients With Symptomatic Bone Metastases in Castration-Resistant Prostate Cancer (CRPC): A Phase III Randomised Trial (ALSYMPCA)]
 
**[http://clinicaltrials.gov/ct2/show/NCT00699751 A Phase III Study of Alpharadin (Radium-223)in Patients With Symptomatic Hormone Refractory Prostate Cancer With Skeletal Metastases (ALSYMPCA)]
 
*[http://clinicaltrials.gov/ct2/show/NCT00667199 Study of Radium-223 for the Palliation of Painful Bone Metastases in Hormone Refractory Prostate Cancer (HRPC) Patients]
 
*[http://clinicaltrials.gov/ct2/show/NCT01106352 A Study of Alpharadin® With Docetaxel in Patients With Bone Metastasis From Castration-Resistant Prostate Cancer (CRPC)]
 
*[http://clinicaltrials.gov/ct2/show/NCT01516762 Radium-223 Chloride (Alpharadin) in Castration-Resistant (Hormone-Refractory) Prostate Cancer Patients With Bone Metastases]
 
*[http://clinicaltrials.gov/ct2/show/NCT01070485 A Study of Alpharadin® in Breast Cancer Patients With Bone Dominant Disease no Longer Considered Suitable for Hormone Therapy]
 
  
 
==Patient drug information==
 
==Patient drug information==
No information available.
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*[https://chemocare.com/druginfo/radium-223-dichloride.aspx Radium-223 (Xofigo) patient drug information (Chemocare)]<ref>[https://chemocare.com/druginfo/radium-223-dichloride.aspx Radium-223 (Xofigo) patient drug information (Chemocare)]</ref>
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*Brief patient counseling information can be found in [http://labeling.bayerhealthcare.com/html/products/pi/Xofigo_PI.pdf the Radium-223 (Xofigo) package insert]<ref name="insert"></ref>
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==History of changes in FDA indication==
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*2013-05-15: [http://www.fda.gov/Drugs/InformationOnDrugs/ApprovedDrugs/ucm352393.htm FDA approved] for the treatment of patients with castration-resistant [[Prostate cancer|prostate cancer]], symptomatic bone metastases and no known visceral metastatic disease. ''(Based on ALSYMPCA)''
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==History of changes in EMA indication==
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*2013-11-13: Initial marketing authorization as Xofigo. Xofigo is indicated for the treatment of adults with castration-resistant [[prostate cancer]], symptomatic bone metastases and no known visceral metastases. ''(Based on ALSYMPCA)''
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==History of changes in Health Canada indication==
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*2013-12-12: Initial notice of compliance (details unavailable)
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==History of changes in PMDA indication==
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*2016-03-28: Initial approval for the treatment of castration-resistant [[prostate cancer]] with bone metastases.
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==Also known as==
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*'''Generic names:''' Ra-223, Radium Ra 223 dichloride, Radium-223 chloride
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*'''Brand names:''' Alpharadin, Xofigo
  
 
==References==
 
==References==
 
<references/>
 
<references/>
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[[Category:Drugs]]
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[[Category:Intravenous medications]]
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[[Category:Radiotherapy medications]]
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[[Category:Alpha emitters]]
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[[Category:Prostate cancer medications]]
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[[Category:EMA approved in 2013]]
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[[Category:FDA approved in 2013]]
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[[Category:Health Canada approved in 2013]]
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[[Category:PMDA approved in 2016]]

Latest revision as of 00:14, 6 July 2024

General information

Class/mechanism: Radioactive pharmaceutical agent (radium-223) that mimics some biologic behaviors of calcium and is incorporated into areas with increased bone turnover, such as bone metastases, by forming complexes with hydroxyapatite. Radium-223 emits alpha radiation at the site of bone metastases, which causes double-strand DNA breaks in nearby cells. The limited penetration of alpha radiation (less than 100 micrometers/uM, less than 10 cell diameters) is believed to limit the risk of adverse side effects. Radium-223's half-life is 11.4 days. Its specific activity is 1.9 MBq (51.4 microcurie)/ng; molecular weight of 223RaCl2: 293.9 g/mol.[1][2][3]

Route: IV
Extravasation: no information

For conciseness and simplicity, HemOnc.org currently will focus on treatment regimens and not list information such as: renal/hepatic dose adjustments, metabolism (including CYP450), excretion, monitoring parameters (although this will be considered for checklists), or manufacturer. Instead, for the most current information, please refer to your preferred pharmacopeias such as Micromedex, Lexicomp, or the prescribing information.[1]

Diseases for which it is used

Patient drug information

History of changes in FDA indication

  • 2013-05-15: FDA approved for the treatment of patients with castration-resistant prostate cancer, symptomatic bone metastases and no known visceral metastatic disease. (Based on ALSYMPCA)

History of changes in EMA indication

  • 2013-11-13: Initial marketing authorization as Xofigo. Xofigo is indicated for the treatment of adults with castration-resistant prostate cancer, symptomatic bone metastases and no known visceral metastases. (Based on ALSYMPCA)

History of changes in Health Canada indication

  • 2013-12-12: Initial notice of compliance (details unavailable)

History of changes in PMDA indication

  • 2016-03-28: Initial approval for the treatment of castration-resistant prostate cancer with bone metastases.

Also known as

  • Generic names: Ra-223, Radium Ra 223 dichloride, Radium-223 chloride
  • Brand names: Alpharadin, Xofigo

References