Advanced Prostate Cancer
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Highly effective targeted therapy for metastatic prostate cancer, using 177Lu-PSMA Radioligand

Hello Friends

This is very effective targeted therapy using highly specific PET imaging and Lutetium 177 (Lu).

LU 177 PSMA therapy or Prostate-Specific Membrane Antigen Therapy, reduces the size of the tumor and stops them from multiplying.

This therapy is approved in Europe and Australia, is clinical trial in US with positive results. See below link to NCI and Australia sites. There are only few hospitals in US use LU 177 PSMA therapy.

Off course, you need to have big money for it in US , but very cheap in Europe .

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

ncbi.nlm.nih.gov/pubmed/286...

Australia Link.

theranostics.com.au/lutetiu...

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Did I read the Austrailian link properly, they are also using it for Neuroendocrine(Small Cell) Prostate Cancer ?

Thanks for posting this!

Softwaremom

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I just did a Google search on (neurendocrine prostate cancer and PSMA). I found an article that said this:

"In general, NEPC differ from conventional PCa histologically by presence of neuroendocrine cells which do not express generic PCa markers like AR, P501S, PSMA, PSAP and PSA but characteristically expresses neuroendocrine markers such as chromogranin A, synaptophysin, CD56, and NSE."

The full article, first published in 2014, is available here:

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

That would make it seem that, since PSMA is the targeting molecule, the one that attracts the Lu-177 and it's attached antibody, to the tumor cells, isn't found, or much found, in neuroendocrine cancers. So this particular treatment might not work.

However, the Australian article did indeed say that they were starting up a clinical trial of Lu-177 on neuroendocrine cancers. So either the article was confused, or the Lu-177 is being used with a different target than PSMA, or there isn't much PSMA but it's enough.

I think the thing to do is to call to Australia and inquire. If you do, let us know what they say.

Best of luck.

Alan

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If you read my previous posting here and didn't see the word "Australia" in it, please read it again. I edited the post.

Alan

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Thanks for clearing this up. It was a little confusing.

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Yes, please tell us what they say. If it worked on endocrene tumors that would be absolutely fantastic! And I think it would be a great thing for many of us to take part in a trial since, even if it doesn't work on the endocrene cells, it would probably get rid off most of the bone mets.

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There is a Doctor in Manhattan that has used Lu-177, for quite awhile---though not approved---and he has had a tremendous amount of success--- in late stage cancers--I think he is oriental---and has a following--I found him by Google, about a year ago---the Search I used if I remember was LU-177, and Prostate Cancer---and somewhere his name came up, with address, and Telephone Number. Most late stage cancers you can assume that some amount is comprised of Neuroendrocrine Pca cells. They tend to be the ones that kill you--as they act like small cell cancer cells---so I have read somewhere---ADT brain fog today.

Nalakrats

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Could this have something to do with it?

progenics.com/product-pipel...

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It looks like Progenics is developing the same treatment as the Lu-177 (also called LuPSMA) treatment, but with Iodine-131 instead of Lutetium-177 as the radioactive element delivering the radiation. If so, I would expect the outcomes to be very similar between the two treatment. I'd be curious to know what the Progenics scientists think will be the advantages and disadvantages of each treatment with respect to the other.

Alan

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Thank you for helping to clarify. I think it was Tall Allen who mentioned something else similar but perhaps even better, more effective, if I remember correctly? It's confusing, but this all sounds promising:

First in-human trial of Actinium-225-PSMA-617

pcnrv.blogspot.com/2016/08/...

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Hello BBruce,

I think this Lu-177 has tremendous potential. It has nothing to do with androgen receptors and should work just as well on men that are castrate resistant as others. It has nothing to do with chemotherapy and should work just as well on men who have become resistant to chemotherapy as others. So I think it really does give hope to many men who would otherwise run out of options.

Will it be a cure? Probably not, at least not for most men. If a tumor cell evolves in such a way that it does not produce PSMA, then this targeting won't find it. Just as castrate resistant cells can eventually become the main population of cancer in a patient, so too PSMA absent cells could eventually become the main population of cancer in a patient - though who knows, as with every other treatment, I fully expect that some men will get lucky and this treatment will work again and again for years and years and may even, for some men, kill all their cancer. I also fully expect that, once the treatment has been around a while and more is known about it, there will be combination treatments like the Lupron+chemo or Lupron+Zytiga treatments but now with Lu-177 added, and as for the other combination, the whole may well be greater than the sum of the parts.

I also think that this is the first of a new category of treatment for which others will be developed using different (not PSMA) molecular targets and different (not Lu-177) radionuclides. And I fully expect that the newer ones will be more powerful than the older ones.

So, hang on brothers and sisters! The cavalry is assembling on the other side of the mountain and the first squadrons are, even now, heading our way.

Alan

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Just wanted to add fews things to what Alen said. This therapy is similar to the Radium treatment. LU 177 is radioactive and has a shorter life than R223. This is experimental and most insurances will not pay for it. If I remember correctly from the results of clinical trials in Germany it extends the life of castration resistance patients by about a year .

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Excellent summary

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I think you will find the cost in Europe still very expensive , around $ 10,000 per injection. In Australia it is $9600 per injection ( up to eight injections could be needed). There is another thread on here which deals with this subject. The trial in Australia is already underway (Melbourne) but the treatment is available privately in Sydney, Brisbane and Perth. Results seem very positive indeed and it is hoped that it will increase life expectancy long term.

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Aggsy

There are number of active and recruiting clinical studies in US, you can try to participate. NCT03042312, NCT00859781, NCT03042468 and others.

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Thanks for the info but I live in Australia. I have been put forward for the trial in Perth but no guarantee will get on it. It is a trial comparing chemo with lutetium . After my experience with chemo not going to do it again !Will probably stump up the cash if unsuccessful getting on trial

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Hi Aggsy

I am Roland I reside in Sydney, I am fairly new and still learning.

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I should have added that it is $9600 Australian per injection.

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I added this info in another post regarding LU177 but worthwhile repeating it here - after salvage radiation failed I investihhated LU177 treatment from Theranostics in Perth. My doc talked to the team at Peter Mac who are running the Australian trials and they advised me NOT to take LU177 as there was risk of leukemia 'in 3 years time'.

This stuff is still experimental and is useful for men with wide spread bone mets with limited life expectation. But as yet is not something to consider as an early treatment.

Regards, Hazard

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For me it would be a risk of leukemia in three years or death from prostate cancer in about three to six months. Might not need my calculator for this one.

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I wonder why should I pay 100000$ to live 1year with a radiated body!!!! just silly question!!

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I wouldn't say it is very cheap here in Europe. My husband and I were looking into this treatment long and hard at the beginning of this year and even got as far as getting an invoice from the hospital we had decided for - should we want to go ahead. If you do four cycles of this - which is what most people need - you end up paying something like 30,000 Euro. Anyway, we were advised against it then because of my husband's liver involvement. This treatment works best for bone mets we were told.

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I am participating in the LU177 clinical trial at Excel Diagnostic Imaging in Houston. I have exhausted all FDA approved treatments and with few treatment options I decided to participate in this clinical trial. I have had one treatment and am scheduled for a second treatment at the end of December. Overall I have had few side effects and feel better with more energy. My PSA dropped from 3450 to 2150 after the first treatment. I will get a total of 4 treatments 8 weeks apart.

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Wow PSA of 3450 , unbelievable

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Good Luck G-d Bless

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LU 177 holds a lot of promise. It uses PSMA as a target (only about 80% of prostate cancer actually expresses PSMA) so it is hard to understand why those cancers that do not express PSMA would be targeted.

I had been working with a man who did elect to go to Germany for LU 177 treatment. His cancer expressed an extraordinary amount of PSMA, but despite his two treatments using it he received no benefit that we could determine. However, I also know two men who did see their cancer go into a remission.

The take home is that LU 177 has great potential, but based on a sample of 1, even not all the prostate cancers that generate PSMA will be responsive to the treatment.

I have written a blog post about LU 177 on the Cancer ABCs Advanced Prostate Cancer Blog which describes the treatment. It can be read at

cancerabcs.org/new-advanced...

Joel

CancerABCs.org

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I went to a hospital in Berlin for a GA-68 PET-CT scan. It showed two small lymph node tumors in the pelvic region.

At that institution they do LU-177 as standard therapy so had a long discussion with Oncology Director and his #2. They indicated that my tumors were too small and insufficient mass to get positive benefit from Luperon treatment.

For others it may be a useful tool to consider, but I never discussed costs. Returned to Canada and just completed 35 sessions of radiation while on Estogen patches.

Saw my clinical oncologist yesterday and he is very impressed with drop in PSA from 12 to now .82 in six months. with Estrogen patches which he has never prescribed before.

Best of luck to all

Peter

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Hi Peter, I am interested to learn more about the Estrogen patches you are using. Will you kindly provide details of the band /concentration and frequency of application.

Thanks,

Barree

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