ADDITIONAL DATA

RaLu Study Evaluated the Safety and Feasibility of Using Xofigo^® before lutetium ¹⁷⁷Lu vipivotide tetraxetan (¹⁷⁷Lu-PSMA)

RaLu is a retrospective medical chart review of 133 patients from German Nuclear Medical centers who received Xofigo →
Taxane → ¹⁷⁷Lu-PSMA vs Taxane → Xofigo → ¹⁷⁷Lu-PSMA therapies¹
RaLu is a retrospective medical chart review of 133 patients from German Nuclear Medical centers who received Xofigo → Taxane → ¹⁷⁷Lu-PSMA vs Taxane → Xofigo → ¹⁷⁷Lu-PSMA therapies¹
13 patients who received taxane both before and after Xofigo were included in both groups
71% received 6 Xofigo injections
56% of patients received ≥4 life-prolonging therapies, including abiraterone (71%), enzalutamide (70%), docetaxel (74%) before starting ¹⁷⁷Lu-PSMA
73% of patients received 1–4 ¹⁷⁷Lu-PSMA cycles and 27% received ≥5 cycles

Table of Xofigo (Radium Ra 223 Dichloride) RaLu Study Findings

Study Limitations: Chart review studies have bias related to treatment selection and unreported variables cannot be fully addressed. Outcomes are based on clinical judgment, with variability in patient and adherence that can result in different outcomes, therefore no conclusions can be drawn.

KEY INCLUSION CRITERIA

Eligible patients were males aged ≥18 years, with bone metastases and a confirmed diagnosis of mCRPC, who had received ≥1 dose of Xofigo and, in any subsequent therapy line, ≥1 dose of ¹⁷⁷Lu-PSMA

Data were retrospectively collected from Sep 2021 – Mar 2022.

^aMeasured from start of ¹⁷⁷Lu-PSMA therapy up to 90 days after last administration.

^bMeasured from start of ¹⁷⁷Lu-PSMA therapy up to 30 days after last administration.

AEs, adverse events; mCRPC, metastatic castration-resistant prostate cancer; SAEs, serious adverse events; TEAEs, treatment-emergent adverse events; ¹⁷⁷Lu-PSMA.

Reported TEAEs and Lab Abnormalities During and Post ¹⁷⁷Lu-PSMA Treatment

REPORTED TREATMENT-EMERGENT ADVERSE EVENTS

Measured from the start of ¹⁷⁷Lu-PSMA up to 30 days after last dose

REPORTED GRADE 3-4 LABORATORY ABNORMALITIES

ASAT, aspartate aminotransferase; N, number of patients evaluated; n, number of patients with the specified event; PSMA,
prostate-specific membrane antigen; Tax, taxane-based chemotherapy; TEAE, treatment-emergent adverse event.

Measured from the start of ¹⁷⁷Lu-PSMA up to 30 days after last dose

Reference

Rahbar K, et al. Presented at European Society for Medical Oncology Annual Meeting; September 9-13, 2022; Paris, France. Return to content

Indication

Xofigo is indicated for the treatment of patients with castration-resistant prostate cancer, symptomatic bone metastases and no known visceral metastatic disease.

Important Safety Information

Warnings and Precautions:

Bone Marrow Suppression: In the phase 3 ALSYMPCA trial, 2% of patients in the Xofigo arm experienced bone marrow failure or ongoing pancytopenia, compared to no patients treated with placebo. There were two deaths due to bone marrow failure. For 7 of 13 patients treated with Xofigo bone marrow failure was ongoing at the time of death. Among the 13 patients who experienced bone marrow failure, 54% required blood transfusions. Four percent (4%) of patients in the Xofigo arm and 2% in the placebo arm permanently discontinued therapy due to bone marrow suppression. In the randomized trial, deaths related to vascular hemorrhage in association with myelosuppression were observed in 1% of Xofigo-treated patients compared to 0.3% of patients treated with placebo. The incidence of infection-related deaths (2%), serious infections (10%), and febrile neutropenia (<1%) was similar for patients treated with Xofigo and placebo. Myelosuppression–notably thrombocytopenia, neutropenia, pancytopenia, and leukopenia–has been reported in patients treated with Xofigo.

Monitor patients with evidence of compromised bone marrow reserve closely and provide supportive care measures when clinically indicated. Discontinue Xofigo in patients who experience life-threatening complications despite supportive care for bone marrow failure
Hematological Evaluation: Monitor blood counts at baseline and prior to every dose of Xofigo. Prior to first administering Xofigo, the absolute neutrophil count (ANC) should be ≥1.5 × 10⁹/L, the platelet count ≥100 × 10⁹/L, and hemoglobin ≥10 g/dL. Prior to subsequent administrations, the ANC should be ≥1 × 10⁹/L and the platelet count ≥50 × 10⁹/L. Discontinue Xofigo if hematologic values do not recover within 6 to 8 weeks after the last administration despite receiving supportive care
Concomitant Use With Chemotherapy: Safety and efficacy of concomitant chemotherapy with Xofigo have not been established. Outside of a clinical trial, concomitant use of Xofigo in patients on chemotherapy is not recommended due to the potential for additive myelosuppression. If chemotherapy, other systemic radioisotopes, or hemibody external radiotherapy are administered during the treatment period, Xofigo should be discontinued
Increased Fractures and Mortality in Combination With Abiraterone Plus Prednisone/Prednisolone: Xofigo is not recommended for use in combination with abiraterone acetate plus prednisone/prednisolone outside of clinical trials. At the primary analysis of the phase 3 ERA-223 study that evaluated concurrent initiation of Xofigo in combination with abiraterone acetate plus prednisone/prednisolone in 806 asymptomatic or mildly symptomatic mCRPC patients, an increased incidence of fractures (28.6% vs 11.4%) and deaths (38.5% vs 35.5%) have been observed in patients who received Xofigo in combination with abiraterone acetate plus prednisone/prednisolone compared to patients who received placebo in combination with abiraterone acetate plus prednisone/prednisolone. Safety and efficacy with the combination of Xofigo and agents other than gonadotropin-releasing hormone analogues have not been established
Embryo-Fetal Toxicity: The safety and efficacy of Xofigo have not been established in females. Xofigo can cause fetal harm when administered to a pregnant female. Advise pregnant females and females of reproductive potential of the potential risk to a fetus. Advise male patients to use condoms and their female partners of reproductive potential to use effective contraception during and for 6 months after completing treatment with Xofigo

Administration and Radiation Protection: Xofigo should be received, used, and administered only by authorized persons in designated clinical settings. The administration of Xofigo is associated with potential risks to other persons from radiation or contamination from spills of bodily fluids such as urine, feces, or vomit. Therefore, radiation protection precautions must be taken in accordance with national and local regulations

Fluid Status: Dehydration occurred in 3% of patients on Xofigo and 1% of patients on placebo. Xofigo increases adverse reactions such as diarrhea, nausea, and vomiting, which may result in dehydration. Monitor patients’ oral intake and fluid status carefully and promptly treat patients who display signs or symptoms of dehydration or hypovolemia

Injection Site Reactions: Erythema, pain, and edema at the injection site were reported in 1% of patients on Xofigo

Secondary Malignant Neoplasms: Xofigo contributes to a patient’s overall long-term cumulative radiation exposure. Long-term cumulative radiation exposure may be associated with an increased risk of cancer and hereditary defects. Due to its mechanism of action and neoplastic changes, including osteosarcomas, in rats following administration of radium-223 dichloride, Xofigo may increase the risk of osteosarcoma or other secondary malignant neoplasms. However, the overall incidence of new malignancies in the randomized trial was lower on the Xofigo arm compared to placebo (<1% vs 2%; respectively), but the expected latency period for the development of secondary malignancies exceeds the duration of follow-up for patients on the trial

Subsequent Treatment With Cytotoxic Chemotherapy: In the randomized clinical trial, 16% of patients in the Xofigo group and 18% of patients in the placebo group received cytotoxic chemotherapy after completion of study treatments. Adequate safety monitoring and laboratory testing was not performed to assess how patients treated with Xofigo will tolerate subsequent cytotoxic chemotherapy

Adverse Reactions: The most common adverse reactions (≥10%) in the Xofigo arm vs the placebo arm, respectively, were nausea (36% vs 35%), diarrhea (25% vs 15%), vomiting (19% vs 14%), and peripheral edema (13% vs 10%). Grade 3 and 4 adverse events were reported in 57% of Xofigo-treated patients and 63% of placebo-treated patients. The most common hematologic laboratory abnormalities in the Xofigo arm (≥10%) vs the placebo arm, respectively, were anemia (93% vs 88%), lymphocytopenia (72% vs 53%), leukopenia (35% vs 10%), thrombocytopenia (31% vs 22%), and neutropenia (18% vs 5%)

For important risk and use information about Xofigo, please see the Full Prescribing Information.

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