How Xofigo Works for Prostate Cancer

Medically Reviewed by Shawn Bookwalter, MS, PharmD, BCPS on August 21, 2024
Written by Dena Westphalen, PharmD
6 min read

Xofigo (radium Ra 223 dichloride) is a medicine that is used to treat prostate cancer in adults. Xofigo may be used to treat prostate cancer that is no longer responding to hormone treatments and has spread to at least one bone in your body but has not spread to any other areas of your body. 

Xofigo is a radioactive medicine that works by providing radiation to your bones. The active radiation ingredient in Xofigo acts like calcium and attaches itself to a bone mineral that is present where there is a lot of bone change in your bones. Bone tumors cause this bone change, which creates the bone mineral. This allows Xofigo to send radiation to bone tumors to kill prostate cancer cells that have formed bone tumors (metastases).

Doses of Xofigo are given by an IV and take 1 minute to inject. Your health care provider will use an equation to calculate the right dose of Xofigo for you. They will use your body weight, the dosage level your cancer needs, the radioactive strength of the Xofigo being used, and the decay correction factor that accounts for the physical decay of the radioactive material. Your health care provider will also prepare the dose of Xofigo and administer it at their office or IV clinic. 

You will receive injections of Xofigo every 4 weeks for a total of six injections. It is unlikely you will receive more than six injections of Xofigo. Talk to your health care provider if you have questions about how many doses of Xofigo you will receive. 

Xofigo was approved by the FDA based on clinical trials that compared Xofigo with a placebo in prostate cancer that had quit responding to hormone treatment and had spread to at least one bone. A placebo is a treatment given that has no active medicine and is used in clinical trials as a control so that the potential benefit of a medicine in a group of people can be compared in a similar group of people who did not receive a medicine.

The clinical trial included 921 people who received one of the two treatments, with 614 people using Xofigo. In this study, about 94% of people were White, 4% were Asian, 2% were Black, and less than 1% were listed as other. They were followed to see how long they stayed alive after starting treatment. This is called overall survival. The median overall survival was 14.9 months in people who used Xofigo, compared to 11.3 months in people who used a placebo. This means that half of the patients who received Xofigo were still alive at 14.9 months after starting to use the medicine. 

Xofigo will start working as soon as you receive your first dose. Your health care provider will usually do regular bloodwork and scans to see how well your body is responding to the treatment. You will need to do bloodwork before each dose of Xofigo to make sure that it is safe for you to receive the dose. You may also have other bloodwork tests after your treatment if your health care provider believes it would be useful. 

The bloodwork tests will monitor your blood counts, such as white blood cells, neutrophils, and platelets, so your health care provider knows that you can continue to use Xofigo safely. If you have certain side effects, such as a change in your urine output, your health care provider may do other tests to make sure it is safe for you to continue to use Xofigo.

These tests may include doing body scans to monitor any tumors in your bones. Your health care provider will discuss any plans for other tests with you.

Side effects are common with medicines that treat cancer, including Xofigo. It is important to tell your health care provider about any side effects you have while you’re using Xofigo and after. They can help to find out if your side effects are serious or provide more information to help you manage the side effects.

Your health care provider will have you do bloodwork before you receive each dose of Xofigo. It’s important to go to all of your bloodwork appointments so that your health care provider can make sure Xofigo is safe for you. These tests will look at your blood cell counts to make sure you do not have an infection or another side effect that makes it unsafe for you to receive Xofigo. This is because Xofigo can cause bone marrow suppression, which can lead to changes in your blood cell counts that can be dangerous and even life-threatening if not treated. 

It is also important to watch for signs of bleeding and infection and to contact your health care provider or go to the nearest emergency center as soon as possible if you think you have bleeding or an infection. These signs may include bruising, fever, shortness of breath, and tiredness. Talk with your health care provider about other signs of bruising or infection you should watch for. 

While using Xofigo, you need to drink plenty of water and stay hydrated. Tell your health care provider right away if you have any signs of dehydration such as dry mouth or an increase in thirst. Also tell them if you have any changes in your urine or burning while urinating. This is important because Xofigo is a radioactive medicine, and you need to stay hydrated for your body to metabolize and clear the medicine safely. 

Your health care provider may also instruct you to take certain medicines before, during, or after your Xofigo IV to help prevent and treat common side effects such as nausea, vomiting, and diarrhea. It is important to follow their instructions. You can also ask your health care provider what else you can do to prevent or treat common side effects. For example, eating bland foods and having multiple small meals throughout the day instead of three large meals can help you prevent and treat nausea and vomiting. 

If you have certain blood cell counts while you use Xofigo, your health care provider may need to pause your doses or even stop your doses altogether. This will depend on your bloodwork. If your Xofigo dose needs to be paused, it is possible that your health care provider will restart the medication once your side effects are treated. 

Xofigo can harm an unborn baby. It’s important to tell your health care provider if you or your partner are planning to become pregnant. You will need to use contraception during treatment with Xofigo and for at least 6 months after your last dose. It’s also possible for Xofigo to cause infertility in people who were assigned male at birth. Talk with your health care provider about the risks to your fertility and any family planning you should do before using Xofigo.

There are no restrictions on the contact you can have with family members or other people, but you should talk with your health care provider about good hygiene practices that you need to follow after each Xofigo dose. This is because radioactivity will be present in your bodily waste, including your urine (pee) and feces (poop) for at least 1 week after each dose. For at least 1 week after every Xofigo dose, it’s important that you use a toilet for all of your bodily waste and to flush it several times after every use. If anyone is helping you use the bathroom, such as a caregiver, they should use gloves and other protective items to handle bodily fluids and prevent radiation exposure to themselves. It is also important that any clothing that comes in contact with urine or feces is washed right away, separate from any other clothing.

Tell your health care provider about any medications you are taking or plan to take before starting to use Xofigo. This includes both prescription and over-the-counter medications, vitamins, supplements, and herbal medicines. Some medicines may interact with Xofigo, and certain ones may increase your risk of bone fractures. Your health care provider will help you find out what is safe for you to take while you use Xofigo. 

The maker of Xofigo has a payment assistance program that may be able to offer coupons for Xofigo doses. Talk with your health care provider and have them look into Xofigo’s website to learn more.