Xofigo Compared to Xtandi For Prostate Cancer Treatment

Xofigo compared to Xtandi is an evaluation that may mean that men with prostate cancer have another treatment option to consider. The Food and Drug Administration (FDA) approved a new medication, Xofigo (radium-223 dichloride), for late-stage castration-resistant prostate cancer on May 15, 2013.  With this new addition of medication on the market, prostate cancer patients will want to ask how it compares to other available medications they are taking or considering. Xtandi (enzalutamide) was approved by the FDA on August 31, 2012, so both medications are fairly new to the market.

How Do Xofigo and Xtandi Work?

Both medications are used for hormone-resistant prostate cancers that have metastasized, or spread to other areas of the body.

Xofigo has an anti-tumor effect. The injectable medication contains radium (a heavy metal), which delivers radiation directly to bone tumors 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.

Xtandi is an androgen receptor inhibitor that works against prostate cancer by causing cell death and decreasing tumor size. Studies show that Xtandi works by interfering with the testosterone and dihydrotestosterone receptors on prostate cancer cells. The drug also stops the hormone receptors from exchanging messages with prostate cancer cells, and this stops cancer growth. It is an oral medication taken at home. Treatment usually lasts eight months.

In studies, Xtandi had a 4.8-month survival benefit over a placebo, while Xofigo had a 3-month survival benefit over a placebo.

Xofigo Compared to Xtandi: Who Is Eligible?

Both drugs are used for advanced stages of castration-resistant prostate cancer that have spread despite hormone therapy.

Xofigo is only for cancers that have spread to the bones and not other organs. It cannot be used with chemotherapy.

Candidates for Xtandi have advanced prostate cancer that has spread or recurred after treatment with docetaxel (chemotherapy) in addition to hormone therapy.

Xofigo Compared to Xtandi: Side Effects

Common side effects of Xofigo may include:

  • Nausea
  • Diarrhea
  • Vomiting
  • Swelling of the legs, ankles, or feet

Common side effects of Xtandi may include:

  • Anxiety
  • Back pain
  • Blood in the urine
  • Diarrhea, dizziness
  • Headache
  • High blood pressure
  • Hot flush
  • Lower or upper respiratory infections
  • Muscle weakness
  • Sleep problems
  • Spinal cord compression
  • Tingling in the arms and legs

Xofigo Compared to Xtandi: Cost

Xofigo 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.

Xtandi costs $7,450 per month, and the average treatment course is eight months, so it is approximately $60,000 for a full course of treatment. Xtandi should be covered by Medicare and by most insurance companies, but men need to check with their insurance provider.

Xofigo Compared to Xtandi: Which One for You?

Your physician can help you determine which medication is right for you based on your symptoms, metastases, and other treatments you are using. If your prostate cancer has spread beyond bones to other organs, then Xofigo is not the right treatment for you. If you have already had hormone therapy and chemotherapy, then Xtandi may be a choice. Ultimately, you are the one who will decide what is right for your health.