Sipuleucel-T vs Radium-223 for Prostate Cancer

A comparison of sipuleucel-T vs radium-223 evaluates these two medications for late-stage castration-resistant prostate cancer. Sipuleucel-T has been available since April 2010, but now with the FDA approval of radium-223 dichloride (brand name Xofigo) in May 2013, that means there are more treatment choices for men with late-stage prostate cancer. With more choices come more decisions to be made. Prostate cancer patients want to know how radium-223 compares with sipuleucel-T (brand name Provenge).

Sipuleucel-T vs Radium-223: How do they work?

Sipuleucel-T is an immunotherapy that was approved by the FDA on April 29, 2010, for men with advanced stage prostate cancer. It uses the body’s own immune system to fight the cancer. Cells are collected from the patient’s blood, modified, and then returned to the patient a few days later via an infusion. These cells help fight prostate cancer. On average, this medication was shown to extend life 4.1 months longer than placebo.

Radium-223 in an injectable medication that has an anti-tumor effect. The medication contains radium (a heavy metal), which delivers alpha radiation directly to bone tumors. The alpha radiation is a short-range radiation that affects only 2 to 10 cells without significantly damaging surrounding tissues. This breaks up double-strand DNA, killing the prostate cancer cells at the site of cancer-induced increased bone turnover. Therapy consists of six injections given at four-week intervals. Compared to the placebo, radium-223 extended life an average of 3 months.

What do they treat?

Both sipuleucel-T and radium-223 are used for prostate cancers that have metastasized, or spread to other areas of the body. Both drugs are used for advanced stages of prostate cancer that have spread despite hormone therapy.

Sipuleucel-T can be used for cancers that have spread to the bones or other organs of the body. Patients who are candidates for sipuleucel-T have minimal symptoms and no pain or pain that does not require narcotic medication. Because sipuleucel-T is an immunotherapy, it can be used before other treatments such as chemotherapy.

Radium-223 differs in that is for use in cancers that have spread to the bones but not other organs. It cannot be used with chemotherapy.

Sipuleucel-T vs Radium-223: What are the side effects?

Both medications have mild common side effects. Common side effects of sipuleucel-T are muscle aches and pains, joint pain, fatigue, fever, chills, headache, and nausea. More serious side effects that need medical attention include breathing problems, chest pains, racing heart or irregular heartbeats, dizziness, nausea, or vomiting after getting sipuleucel-T. The most common side effects of radium-223 are nausea, diarrhea, vomiting, and swelling of the leg, ankle, or foot.

Sipuleucel-T vs Radium-223: What is the cost?

Both medications are expensive but may be covered by insurance or patient assistance plans from the manufacturers. Sipuleucel-T costs over $90,000, but most insurance plans and Medicare usually cover it. The drug’s manufacturer, Dendreon, offers financial assistance. It may be provided free for patients without insurance or who demonstrate a financial need. For patients who qualify, Dendreon may reimburse or offer financial assistance for copays, co-insurance, or deductibles. Radium-223 costs $69,000 for the complete course of therapy. Because it is new, patients need to check with their insurance carrier for coverage. Bayer will have a patient assistant program to help with costs.

Your physician can help you determine which medication is right for you based on your symptoms, metastases, financial situation, and other treatments you are using. Ultimately, you and your loved ones will have to weigh the costs and benefits of treatment choices to make a decision that is right for you.

Read more in our Prostate Cancer Health Center.