Final results show that combining radium-223 (Xofigo) with enzalutamide (Xtandi) helps patients with bone-predominant metastatic castration-resistant prostate cancer live longer than treatment with enzalutamide alone.
Patients who received the combination lived a median of 38.2 months, compared with 32.6 months for those on enzalutamide alone. The combination also delayed visible tumor growth on scans, extending radiographic progression-free survival to 19.2 months versus 16.4 months. The survival benefit became especially clear after 18 months of treatment.
The treatment usually includes daily enzalutamide plus six radium-223 injections given every four weeks. Because of fracture risk, bone-protecting medications must be used during therapy. Although side effects such as high blood pressure, fatigue, and anemia were slightly more common with the combination, serious problems were manageable and few patients stopped treatment. The results support this dual approach as a strong first-line option for patients whose cancer has mainly spread to the bones.