Lutetium-177 PSMA - A new experimental treatment

[AlanMeyer]

Alan Lawrenson posted an interesting reply to a recent posting on "Cracking neck pain" in which he referenced clinical trials in Australia of a new treatment. I looked that treatment up and found this article:

ncbi.nlm.nih.gov/pmc/articl...

My inexpert reading of that article led me to the following conclusions:

1. The treatment

About 80% of men with prostate cancer have great overexpression of an antigen named "prostate‐specific membrane antigen" (PSMA) on their tumor cells. ("Overexpression" means that the tumor cells are producing a lot more of these antigen molecules than normal cells.) PSMA is a molecule that appears on the surface of tumor cells that can be "recognized" by an antibody that will bind to it. (An "antibody" is a kind of molecule that latches on to another molecule, an "antigen" like PSMA, and leaves other molecules alone.) Lutetium-177 is a radioactive isotope of the element Lutetium that can be manufactured and bound to an antibody for PSMA. A solution containing this compound is injected into the patient. The molecules of antibody + Lu-177 bind to the PSMA on the surface of cancer cells, and the radiation kills them. Apparently, very few other cells are damaged by the treatment.

Unlike Xofigo, this "targeted therapy" attacks cancer in soft tissue, not just in bones. So if you've got metastases, for example, in the liver, lungs, stomach, etc., they can be treated by this therapy.

2. Results.

Not everyone with PCa has lots of PSMA. Those who don't won't benefit. However 80% is a pretty good percentage who do.

Side effects look to be pretty mild. It looks like most men tolerate this treatment very well.

I don't see any evidence that this is a cure even for those who do have lots of PSMA. Like all of the other treatments, it appears that cancer adapts and eventually there will be tumor cells that don't express PSMA and are not killed by the treatment.

Also like all of the other treatments, some men will benefit a whole lot, others only a little, and others not at all. However, this treatment is unlike chemo, ADT, or immunotherapies and it looks to me like failing all of the other treatments does not mean you'll fail this one. I think that's what we need - new treatment types that work when the others have stopped working.

3. How do you get it?

It's currently only available in clinical trials. Those of us who are ready to try clinical trials might look for it.

Alan

[ctarleton]

This clinical trial recently showed up for advanced patients' consideration:

clinicaltrials.gov/ct2/show...

Charles

[AlanMeyer in reply to ctarleton]

I checked out the clinical trial document found by Charles.

It looks like the trial is only available in Los Angeles and Houston. I'm guessing that your local hospital can't do it because you've got to start with a freshly manufactured batch of radioactive Lutetium that has been freshly combined with the antibody - all of which requires a nuclear facility and a sophisticated lab. Every day spent transporting the stuff after manufacture is a day that weakens the radioactivity of the material. It may also be dangerous stuff to handle and they may not want to give it to just any hospital to administer the drug.

However, for those who can make it to L.A. or Houston, it looks like they're recruiting 200 participants. I assume some have already been recruited, but as of June 11 (the date that the document was last updated) they were still recruiting new patients.

Alan

[MelaniePaul]

I might add here that in Germany, for example, you can get the treatment in Munich and Bad Berka and some other university hospitals but you have to pay for it yourself since this is not yet a recognized therapy. One cycle of this treatment - and you can do up to four cycles - can cost up to 15,000 Euro.

We were told here by our oncologists, as well as by the ones in Germany, that this therapy works not too well on soft tissue tumors, particularly not on the liver.

Mel.

[Sisira]

Thanks Alan for elucidating the modality of this innovative and experimental treatment approach using nuclear medicine, which can be a game changer in treating prostate cancer once we know its long-term response and toxicity. I have come to know that Melbourne's Peter MacCallum Cancer Centre in Australia is conducting trials using this lutatium PSMA radionuclide therapy or LuPSMA.

Since prostate cancer is a dynamic field, a pressing question could be whether this therapy can be brought forward and given to men earlier in the course of their cancer.

On the other hand, we need to be judicious about where we place it in a man's life expectancy because some radiotherapeutics can eventually cause cancer themselves.

It could be counterproductive for a man with a good life expectancy because while it may rid him of prostate cancer, down the track there is a chance it may cause another cancer.

Hope LuPSMA with proper experimentation and risk mitigation will emerge as a boon for our rescue!

Sisira

[wagscure259]

Dr Tagawa at Cornell Weill ?

[AlanMeyer in reply to wagscure259]

It looks like there is a clinical trial (not treatment outside a trial) at Cornell Weill for which Dr. Tagawa is the principal investigator. Melanie found that you can get the treatment outside of a trial in Germany but here, in the U.S., I think it's illegal to use unapproved treatments except in the context of a trial.

Here are some references:

weillcornellgucancer.org/20...

jcto.weill.cornell.edu/open...

Alan

[ctarleton in reply to AlanMeyer]

See also:

clinicaltrials.gov/ct2/show...

Charles

[paulofaus]

In my home town, Perth, western​ Australia, there is a company called Theranostics, which lists Lu177 for PCa as a treatment they offer. Not sure of the cost though.

[AlanLawrenson in reply to paulofaus]

As you can see on this thread, I reported that my 76 yo brother had treatment in Sydney, by the guy from Theranostics who travels from Perth twice a month. Peter MacCullum Cancer Institute have complete one trial and are recruiting for another which will be nation wide. St Vincents Hospital in Sydney have already treated 30 men.

My brother has seen all but one of his mets disappear after two injections which cost him A$20K with no insurance re-imbursement. His PSA was 9.9 before the treatment and is now 1,24. It is possible the last spot on arib might now have gone as well. Note that he had been on enzalutamide (which brought his PSA from about 20 to just under 10 before the LuPSMA therapy). Also a strict diet and exercise regime.

Sure the long term effects of this therapy are unknown, but when you are in a terminal state, who cares.

I'll be putting up a new Newsletter on my web site (anabcofprostatecancer.com.au) on this therapy within the next week or so. I would appreciated any further input on this topic in the interim.

[Hidden in reply to paulofaus]

I have had a consultation with Dr Lenzo of theranostics and the cost is $9600 per injection. Depending on success / failure up to 8 injections can be given over 2 years or so. Dr Lenzo put me on Xtandi to see if this would work prior to considering the lutetium treatment . After 10 weeks my psa has dropped from 30 to 5 so will keep on with this for the present.