When Keith Bosse's prostate cancer metastasized to his spinal column, his options for treatment were limited.
The solution, according to Dr. Richard Conklin, oncologist, was to try a brand new radioactive medicine called Xofigo (zo-FEEG-oh).
Bosse is the first patient in the Dakotas to receive the drug.
“The treatment is not for every patient,” Conklin said. “Certain conditions must be in place for a patient to be a candidate for this procedure. The treatment is for patients with Stage 4 widespread metastatic prostate cancer. It has been shown to prolong survival with minimal toxicities, allowing us to treat older patients, even with multiple medical problems.”
Xofigo was approved for use in May by the U.S. Food and Drug Administration. Regionally, the only other medical centers that have done the procedure are the University of Minnesota and the Mayo Clinic, according to an Avera news release.
The medicine is expensive, costing $10,000 a dose, Bosse said. The drug is injected once a month for six months, making the total cost of the treatment $60,000. The family expects Medicare to cover the majority of the cost, because the drug is FDA approved, but that is not known yet, said Kathy Bosse, Keith's wife.
" I didn't know what to think," said Keith Bosse, a retired farmer from Britton. "Then I thought, well, if I am going to be a guinea pig, I will be the guinea pig."
Bosse had received radiation and chemotherapy, but his prostate specific antigen test numbers kept going up, suggesting the cancer was not getting any better.
Conklin said he became aware of the favorable research on Xofigo and decided to recommend it for Bosse.
A radioactive isotope is compounded with a molecule that directs the medicine to a certain part of the body, said David Martin, lead nuclear medical technician at Avera St. Luke's.
In Xofigo, the molecule acts like calcium being taken up by the bones, he said. It is directed to spots where the bone has cancer. The radioactive substance destroys the cancer and breaks down the DNA, which would allow it to spread, he said.
"We are fortunate to have Dr. Conklin," Martin said. "He is very proactive. If there is a treatment that he thinks will help the patient, we are on it. This is not the first time we have been the first Dakotas or the Upper Midwest with a treatment."
Xofigo is manufactured by Cardinal Health in Denver, Colo., the only place in the country where it is made. The drug was shipped to Aberdeen in a lead-lined container to protect those handling the package from radiation.
Martin said he administers nuclear medicine in a syringe that is inside a tungsten shield.
Avera's nuclear medicine department performs diagnostic and therapeutic procedures. The most common diagnostic uses for nuclear medicine at Avera is to detect coronary disease, Martin said. The most common therapeutic uses are for thyroid cancer, he said.
The Xofigo, "takes a lot of me" and "I feel lousy," said Keith Bosse, who was warned he would not feel better immediately.
"We are excited about the opportunity to use the medicine," Kathy Bosse said. "It is something to look forward to, and we hope that it works."
The family already feels grateful that he has been able to live with prostate cancer for 13 years.
"I am very happy to be alive," Keith Bosse said.
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