Initial experience with 223Ra vial delivery (Alpharadin®) vs. unit dose delivery (Xofigo®)

2526 Objectives Radium-223 (223Ra) dichloride is used to treat castrate resistant prostate cancer that that has spread to bones. 223Ra can be delivered to the nuclear medicine clinics in either a vial or a unit dose. At our institution we used both methods: vial for the early access program (EAP) and unit dose for the FDA-approved product. With the protocol used for the EAP method, the prescribed dose was drawn using a syringe and then administered using a lead-shielded pump and a 10-minute infusion. Using the unit dose method, we administered the dose by hand over 1-3 minutes. Therefore, we compared the two administration methods for the amount of residual measured after administration. Methods This is a retrospective review of all the 223Ra doses administered at Stanford from Nov 2012 to Dec 2013. We compared the prescribed dosage, the administered dosage and the values of residual activity. Immediate adverse reactions were also recorded if present. Results There were 21 men, 58-85 year-old (average: 71.4 ± 9.8) who had 223Ra administrations. A total of 23 doses were delivered using the vial method (EAP), and 29 administrations were completed using the unit dose method. There were no immediate adverse reactions noted during any of the 52 administrations. The dosages and residual measurements post-injection are summarized in the table below (all in μCi). All the differences between Alpharadin® and Xofigo® deliveries were statistically significant. Conclusions The use of the unit dose method is more convenient for the patients, technologists and physicians (decreased administration time), reduces the residual activity while maximizing the dosage delivered to the patients, and has no increased rate of adverse reactions.