New treatment option gives hope to advanced prostate cancer sufferers, whose cancer has spread to the bones.

 

Singapore is the first country in the Asia-Pacific region to offer a breakthrough alpha-emitting radioactive therapy called Radium-223 dichloride (Xofigo) by pharmaceutical company Bayer for advanced prostate cancer that has spread to the bones.

 

Increase in prostate cancer incidences

This is good news for advanced prostate cancer sufferers, following recent reports of a significant increase in prostate cancer incidences among several Asian countries including Singapore, Japan, Philippines, South Korea, Thailand and China.

In Singapore, prostate cancer is the third most common cancer and the sixth leading cause of death from cancer in men. According to the Singapore Cancer Registry data, prostate cancer is overtaking liver cancer as the third most common cancer among men over the last five years, at the rate of 28 per 100,000. This incidence rises with age. By 2030, this burden is expected to increase as one in five Singaporeans will be aged above 65.

Also, an alarming 90 percent of men with castration resistant prostate cancer (CRPC) are known to develop bone metastases, where cancerous cells spread to the bones.

Bone metastases are the main cause of morbidity and death in prostate cancer patients. The five-year survival rate is 56 percent in men with prostate cancer without bone metastases and only three percent in those with bone metastases.

As prostate cancer is a slow-growing cancer and often exhibits no symptoms, many patients present themselves too late. “As prostate cancer is often discovered at a late stage, at least 20 to 40 percent of patients with prostate cancer with bone metastases fail to receive chemotherapy because they are either too frail and/or not eligible, or have co-existing conditions that preclude its use, or they simply decline treatment,” said Dr Ng Quan Sing, consultant, Division of Medical Oncology at the National Cancer Centre Singapore (NCCS).

 

New treatment option

Radium-223 dichloride can be conveniently administered in an outpatient setting, resulting in patients being able to return home immediately after treatment. A monthly treatment course of one-minute intravenous injection is administered over six months. After six months of treatment, patients are assessed on their prostate cancer condition and whether further treatment is required.

It works by mimicking calcium to target specifically the areas with bone metastases. Alpha-particles deliver an enormous amount of energy over a very short distance, providing potent cancer killing effects on the bone metastases while limiting damage to surrounding tissues. Common side effects of Xofigo include nausea, diarrhoea, swelling of the arms or legs (peripheral edema), and low blood cell counts. The final fee of the treatment depends on where the patient is being treated, but it is between S$9,000 to $11,000 (per dose per month). The cost of Xofigo is priced within the range of new and current therapies for metastatic castration resistant prostate cancer, according to a Bayer spokesperson.

According to a Landmark ALSYMPCA trial, which was stopped early due to benefits shown and involved Singapore, Radium-223 dichloride as compared with placebo significantly prolonged survival by 3.6 months, with a 30 percent reduction in risk of death.

Singapore is also participating in an ongoing Asian Population Study to further reinforce the safety and efficacy of Radium-223 dichloride for Asian men with CRPC.

 

SIDEBOX: Is the treatment covered by insurance? A Bayer spokesperson said, “Insurance coverage for cancer incidence would typically be covered under a Critical Illness protection plan, which is designed to give comprehensive financial support to battle against an unexpected critical illness. Generally, Critical Illness Plans can cover early, major and catastrophic critical illnesses, including cancer, heart disease and stroke. Some insurance companies also offer Critical Illness protection plans that extend to major cancer relapse as well. In general, the level of payout, dependent on the definition of the coverage/policy, should be sufficient to supplement or cover the cost of cancer therapies, including radioactive therapy. Majority of Singaporeans/PRs have a basic MediShield plan which is a basic medical insurance scheme, with deductibles and co-payment. The MediShield plan provides claim limits of an additional S$1,240 per monthly treatment cycle for selected cancer treatments. For patients with private insurance, the cancer treatments are as charged and subjected to policy year limit, dependent on the tier of the insurance coverage they have purchased. Please check for details of critical illness plans directly with insurance companies.”

 

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