Anecdotal, but I am hearing some community hospital level interest for Xofigo. Persuading hospitals in our network to work on building out the codes for Xofigo, and start judging the financial reimbursement impact. Early yet, but I will eventually get a good feel for demand regionally in coming weeks/months.
I think you'll see people getting both. Send for RA223, and strart Cometriq at same time, or shortly after. I think the combo of Cometriq and Zytiga trial is a very interesting one, and could trump them all...rising PSA c/w biochemical failure and give Cometriq/Zytiga combo...would be fantastatic. This is the technology that starts bringing oncology closer to HIV world...combos of oral agents that prolong life. That trial, if positive could spell billions for EXEL.
I am a practicing oncologist and have already sent 2 patients for treatment with Xofigo. Main problem in NY is getting State approval for this particular agent. It will be used but is no magic bullet. Adds 4 months to survival just like Abiraterone,etc. Understand that when we run out of treatment options for our patients we will try anything approved and reasonable. Plenty of room for Carbo
Hbomb, I know you're in the radiological field, and I remember you said that there were significant logistical challenges to distributing and upkeeping stockpiles of drugs like Xofigo. What is your current assessment of Cabo's chances vs. Xofigo in late state metastatic PC given each AE profile, efficacy, cost, and the logistical challenges involved?
"Hbomb, I know you're in the radiological field, and I remember you said that there were significant logistical challenges to distributing and upkeeping stockpiles of drugs like Xofigo. What is your current assessment of Cabo's chances vs. Xofigo in late state metastatic PC given each AE profile, efficacy, cost, and the logistical challenges involved?"
I would like to see what demand is before I make any comment on supply. I really don't know what supply is out there or what kind of demand Algeta/Bayer thinks there is. I also want to see how much reimbursement is given before commenting on whether some logistical issues may pose a problem. Traditionally radiotherapeutics have had weak reimbursement for a variety of reasons. The shelf life according to website
"Stability and Storage
When a unit dose syringe is provided by Cardinal Health
central radiopharmacy, the shelf life of the Xofigo dose in
the syringe is 48 hours at room temperature.1
Store Xofigo at room temperature, below 40°C (104°F) in
the original container or equivalent radiation shielding."
Efficacy=unknown (Cabo has no survival data yet)
Logistical= Cabo advantage because prescribing oncologist can get the reimbursement and send patients home with monthly pill supply. = much easier with financial incentives tied to prescribing Cabo vs Xofigo
Cost would be similar considering cancer stage and AE profile would favor Xofigo unless you consider unknown long term secondary cancer risks. Was going to paste relevant quote but too long to fit.
If there is demand for Xofigo, it will be interesting to see how many patients forego Docetaxel.(Docetaxel's patent expired I believe) Technically patients must be unfit for Docetaxel if patients are to receive Xofigo without prior Docetaxel. Hospital and radiologist get reimbursement for Xofigo, so I wonder how that plays out with prescribing oncologists. Remember prescribing oncologist can get reimbursed for Cabo, not hospital or radiologist.-- out of space