Can I Take Xofigo after Provenge?

Taking Xofigo after Provenge could potentially be a treatment sequence for metastatic prostate cancer, after more research has been done. With all of the different clinical trials in castration resistant prostate cancer and the approval of multiple different different drugs, some patients might wonder if they can take Xofigo after Provenge. Unfortunately, there is not a lot of good research to guide you and your doctor once you have developed castration resistant prostate cancer or developed progression such as increased PSA or a new or more significant spread of the cancer on androgen deprivation therapy. Current research is ongoing to determine how these new agents can best be combined or sequenced to improve outcomes for patients with castration resistant prostate cancer.

What is Xofigo?

Xofigo is a novel radioactive therapy that targets prostate cancer that has spread to bone. It demonstrated an improved survival and was well tolerated by patients with castration resistant prostate cancer in the clinical trial that led to its approval by the FDA. Additionally, Xofigo increased the time to development of asymptomatic skeletal problems such as a pathologic fracture or spinal chord compression.

Xofigo is only indicated when prostate cancer metastasizes or spreads to bone but has not yet spread to other organs. Use of Xofigo is usually offered when medical or surgical treatments to lower levels of testosterone, the hormone that allows castration resistant prostate cancer to grow and spread, have failed or have been ineffective.

Xofigo is not currently recommended in combination with chemotherapy due to potential side effects unless you are participating in a clinical trial.

What is Provenge?

Provenge is a a form of immunotherapy for advanced prostate cancer. This means that it helps your body’s immune system attack prostate cancer by stimulating your own immune cells. It is normally used in men who have not responded to hormone treatment and are either asymptomatic or have very few symptoms of advanced prostate cancer.

Xofigo side effects

Common side effects of Xofigo include:

  • Diarrhea
  • Nausea
  • Swelling
  • Vomiting
  • Low blood counts

Provenge side effects

While Provenge is well tolerated by most patients, all therapies have potential side effects. Common side effects of Provenge include:

  • Chills
  • Fatigue
  • Fever
  • Joint pain
  • Headache
  • Muscle aches
  • Nausea

Sequencing of Provenge and Xofigo

Currently there are plans for a small clinical trial to examine the effects of combining Provenge with Xofigo. There is very little data available today to help you and your doctor decide if you can take Xofigo after Provenge.

There are certainly some potential concerns, but also possible benefits. While it is hoped that combining the drugs will lead to better survival with fewer side effects, the effect of each drug on the other is not yet known. We do not know if the combination of the two drugs will be better, cause more or less side effects than each on their own.

Read more in our Prostate Cancer Health Center.

References

Kantoff PW et al. Sipuleucel-T immunotherapy for castration-resistant prostate cancer. New England Journal of Medicine 2010 Jul 29; 363(5): 411-22

Liu JJ and Zhang J. Sequencing systemic therapies in metastatic castration-resistant prostate cancer. Cancer Control 2013 Jul; 20(3): 181-87

Small EJ and de Bono JS. Prostate cancer: Evolution or revolution? The Journal of Clinical Oncology 2011Sep 20; 29(27): 3595-98