There’s hope for men with advanced prostate cancer who have run out of treatment options.
Actinium-225 is a drug that has been administered to about 40 patients at Inkosi Albert Luthuli Hospital since last year, and it has made a huge difference in their lives without the side effects that come with other forms of treatment like chemotherapy.
But due to costs, he treatment is no longer available and doctors find this heartbreaking.
Nuclear medicine physician Dr Mariza Vorster says Actinium-225 is a powerful and effective form of treatment which prevents the cancer from quickly regrowing.
“It's an outpatient therapy, which you can imagine for patients is wonderful. They come as an outpatient, it's an injection that takes less than a minute and then they only come back in two months for the second injection,” says Vorster.
The treatment, she says, is repeated four times and scans are done before each new dose to determine their progress. She says by the third dose you can already see a huge difference.
“But more importantly, patients start feeling better. Their quality of life improves so they take less and less pain medication. Or if they were in a wheelchair, they now only have to use a crutch. Or patients that spend their time lying in bed can now get up. So, it really makes a quality of life difference,” says Vorster.
The most common side effect is a dry mouth.
Vorster says prostate cancer is the most common form of cancer in men and responsible for the second highest number of cancer-related deaths. In addition, it recurs in a large percentage of patients even if it has been successfully treated.
“And when it's metastatic (has spread) it's quite hard to treat. And once chemotherapy fails, it also becomes harder to treat,” she says.
By the time Actinium-225 is administered to patients, they are usually at death’s door and this is a last resort, but so far the drug has led to a visible improvement in their quality of life.
“For most patients, they get better and we really buy them time. When they get to us, nothing else has worked. So, seeing it in that light, it's quite remarkable that even at that very last point, you can still get cured in some cases. So, you can imagine if you used it earlier, what that effect might be.
But we don't often speak about cure; we say partial treatment response. So, a complete treatment response is what is known as a cure. But that is the exception rather than the rule.”
Vorster was previously based at Steve Biko Hospital in Pretoria where they first ran a trial on this drug and the outcomes have been positive. However, at Inkosi Albert Luthuli Hospital the drug was administered as “compassionate use”.
“And now, you're starting to get five-year reports of people surviving even five years after the treatment which is very encouraging if you think again that at the point they were referred, they had no other options left and nothing had worked.”
The results have been astounding. But even though Actinium-225 has proven to be a game-changer in the treatment of prostate cancer, the treatment has hit a snag. Funding.
Although Vorster could not talk about the cost of the medication, the family member of a patient revealed that one shot could set you back by R80 000. While it is available at a select few private hospitals, it is not covered by medical aids.
“So it's still mostly seen here as a research or an emerging form of therapy. It's not well established yet and medical aids need big prospective trials which are all ongoing and should be done soon, after which they start funding new therapies,” says Vorster.
Now that the budget at Inkosi Albert Luthuli has been slashed, patients can no longer receive the free treatment because the hospital cannot afford to buy it. At the moment Actinium-225 is only manufactured in three countries and given its half life, which means that it must be transported and used as swiftly as possible to be effective, it just adds to the complexity of the issue.
For Vorster and other doctors treating these patients it's heartbreaking.
“We have the expertise and we can get the drugs but we don't have the money and that seems such a shame when you know you can help people rather than sending them home to die with their families,”she says.
“I've really seen some miracles, true-life miracles and now to not be able to even offer it is really just heartbreaking.”