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Radium-223 was the first alpha-emitting drug ever approved (2013). It homes to bone like calcium and treats prostate cancer that has spread only to bone.
Radium-223 is a calcium mimetic incorporated into bone matrix at sites of metastatic bone turnover, where each decay chain delivers four alpha emissions over a range of a few cells, killing tumour while largely sparing marrow. It is given intravenously to men with symptomatic castration-resistant prostate cancer whose spread is confined to bone without visceral disease. ALSYMPCA showed overall survival of 14.9 versus 11.3 months (HR 0.70) and fewer skeletal events, and it became the first alpha-emitting drug ever approved (2013). ERA 223 showed excess fractures when combined with abiraterone, now contraindicated without bone protection, while PEACE III (2024) with enzalutamide plus bone-protecting agents was positive for rPFS and overall survival. How to sequence it with 177Lu-PSMA therapy is unresolved. Simply put, it is a radioactive calcium look-alike that homes to bone metastases.
Calcium mimetic incorporated into bone matrix at metastases; four alpha emissions per decay chain.
1.Radium-223 dichloride binds its target on the cancer cell or is taken up by it.
Background: ADC sequencing, Antigen escape (antigen loss, lineage switch), BCG-unresponsive, Castration-resistant prostate cancer (CRPC), Circulating tumour DNA (ctDNA). Also on OnCo: Resistance: how tumours escape each drug class · Lines of therapy.
Given by infusion or injection in a clinic or hospital outpatient department, so it is a Part B drug: Medicare pays 80% after the Part B deductible and the patient owes 20% coinsurance, uncapped in Original Medicare unless a Medigap policy applies. HCPCS A9606. Six monthly injections.
Covered under the medical benefit with prior authorisation confirming diagnosis, biomarker status and line of therapy; site-of-care policies may steer infusions away from hospital outpatient departments. Symptomatic bone metastases without visceral disease, per the label.
20% Part B coinsurance on a high-cost infusion adds up quickly: Medigap Plan G or N, Medicare Advantage maximum out-of-pocket, Medicaid dual eligibility, or a charity fund are the usual buffers.
Sources: Medicare.gov: Chemotherapy · Medicare.gov: Prescription drugs (outpatient, Part B). Not medical or financial advice; verify with your plan.
Sources: NICE TA412 · SMC advice: radium-223 dichloride. Funding decisions are indication-specific and change monthly; verify with NICE and your treating team.
| Region | Year | Indication |
|---|---|---|
| US | 2013 | Symptomatic bone-metastatic CRPC without visceral disease |
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Query for this drug: (TITLE:"Radium-223 dichloride" OR ABSTRACT:"Radium-223 dichloride" OR TITLE:"Xofigo" OR ABSTRACT:"Xofigo") AND (cancer OR tumor OR tumour OR oncology OR carcinoma OR lymphoma OR leukemia OR leukaemia OR myeloma OR sarcoma OR melanoma OR glioma). Results are unfiltered search hits about Radium-223 dichloride, not a curated reading list.
Shares PEACE-3 (EORTC 1333), Bone-modifying agents (bisphosphonates, denosumab), Bone metastases and skeletal-related events, Osteosarcoma.
Shares ALSYMPCA, PEACE-3 (EORTC 1333), What follows what in castration-resistant prostate cancer, Prostate cancer drugs in England: what NICE recommends, and what it refuses.
Shares Karim Fizazi, Prostate cancer drugs in England: what NICE recommends, and what it refuses, Bayer, Prostate cancer.
Shares Bayer, Targeted alpha therapy, Metastatic castration-resistant prostate cancer, Prostate cancer.
Shares PEACE-3 (EORTC 1333), Bone-modifying agents (bisphosphonates, denosumab), Bone metastases and skeletal-related events, Metastatic castration-resistant prostate cancer.
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Shares Karim Fizazi, Alpha vs beta emitters, Randomise the order of treatment, not only the drugs: a strategy platform for metastatic prostate cancer, Metastatic castration-resistant prostate cancer.
Shares What follows what in castration-resistant prostate cancer, Randomise the order of treatment, not only the drugs: a strategy platform for metastatic prostate cancer, Prostate cancer drugs in England: what NICE recommends, and what it refuses, Metastatic castration-resistant prostate cancer.