Lutetium 177 treatment options - Advanced Prostate...

Advanced Prostate Cancer
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Lutetium 177 treatment options

Engraver68
Engraver68

I have advanced prostate cancer and recent PSMA scan identified bone metasteses in pelvis. I have been prescribed zolodex and Zytiga PSA is dropping thankfully but I am sure this will be temporary. I a, interested in exploring treatment with Lutitium 177 I think it is currently only available in Germany. Does anyone have information of this treatment and or if this is available elsewhere in UK or Eurooe

46 Replies
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Here's some info about it (see links at the bottom of the article):

pcnrv.blogspot.com/2017/09/...

Here's the latest meta-analysis. Two-thirds had at least some PSA decline. And those with any PSA decline had a 71% greater overall survival compared to those who did not enjoy a PSA decline from it.

ncbi.nlm.nih.gov/pubmed/300...

In Europe outside of Germany, there is a trial in Italy:

clinicaltrials.gov/ct2/show...

I had the treatment in Munich at the Technical University. The treatment is available in Munich, Heidelberg, Bonn, Bad Berka in Germany and in Utrecht in the Netherlands. I understand it is also available in Australia

Lombardi24
Lombardi24
in reply to tango65

What was the expense if I may ask?

tango65
tango65
in reply to Lombardi24

The treatment is about 8K euros. To know if your are a candidate for the therapy you will need a Ga 68 PSMA PET/CT. They charge close to 3 K euros for the PET/CT study. There are clinical trials for this type of PET/CT. Search in clinicaltrials.gov for Ga 68 PSMA and for 18F DCFPyl.

Flydoggy
Flydoggy
in reply to tango65

Tango, what determines candidacy?

tango65
tango65
in reply to Flydoggy

I was hormone sensitive and I had lymph node metastasis in a Gallium 68 PSMA PET/CT. It seems to me that in Munich (Technical University or Ludwig Maximilian University) what is required is the presence of metastasis in a PSMA PET/CT study.

I heard you needed to be castrate resistant or have a rising PSA. I’m not sure if this is accurate. 👍

tango65
tango65
in reply to Apollo123

I was not castration resistant. My PSA was 10 and it was rising rapidly. I was rejected by Heidelberg but I was accepted in Munich by the Technical University and the Ludwig Maximilian University.

Flydoggy
Flydoggy
in reply to tango65

What made you choose Lu177? We are considering it as well but have been told it is "too soon". Post prostatectomy and radiation...PSA still rising.

tango65
tango65
in reply to Flydoggy

I thought I did not have anything to lose, except for some money. I had lymph node metastases around the inferior vena cava and abdominal aorta which could not be treated (according to my MO) with radiotherapy or surgery.

Besides the Ga 68 PSMA PET/CT does not visualize all the metastases. A more systemic treatment is needed.

I believed the treatment with Lu 177 was a way to treat the metastases without mayor side effects. The Lu 177 kills hormone sensitive and castration resistant cells. I thought the Lu 177 treatment could be a complement to the ADT therapy with Lupron and Casodex.

I had one Lu 177 treatment only because the metastases were gone according to a new Ga68 PSMA study done 6 weeks after the first treatment. They do not treat if metastases are not visualized, so they canceled the second treatment.

I did not have any side effect, except for some edema the day after the infusion which was treated with one dose of Lasix.

My PSA is 0.06 so it is impossible to know what happened to the metastases in the last 2 years. To get another Ga68 PSMA study the PSA has to be >0.2. I had a couple of abdominal-pelvis CT scans for different reasons and I do not have enlarged lymph nodes in the pelvis or abdomen.

.

Flydoggy
Flydoggy
in reply to tango65

Thanks for all the information, I appreciate you sharing your story. Would you mind telling me where you went and what the cost was?

Flydoggy
Flydoggy
in reply to tango65

And do you have a contact email or ph #?

tango65
tango65
in reply to Flydoggy

I went to the Technical University in Munich. I was accepted in this University , the Ludwig Maximilian University in Munich and also in Bonn. Heidelberg rejected me because I was not castration resistant and I had not failed other treatments.

The treatment cost about 8K euros. To know if your are a candidate for the therapy you will need a Ga 68 PSMA PET/CT and a renal scintigraphy study. They charge close to 3 K euros for the PET/CT study. There are clinical trials for this type of PET/CT. Search in clinicaltrials.gov for Ga 68 PSMA and for 18F DCFPyl.

Possible contact :

Dr Tauber at the Technical University of Munich:

mriu.de/k_mit.html robert.tauber@tum.de

Flydoggy
Flydoggy
in reply to tango65

Thanks for that. Just had the GA 68 scan 10 days ago. We were told that I’m not a candidate for the same reason, but only checked with Heidelberg. Will contact the others and see what they say.

Jenbt
Jenbt
in reply to Flydoggy

Can I ask why you were rejected from Heidlberg?

Jenbt
Jenbt
in reply to tango65

Hello, we are too considering Lu177 treatment, can I ask if a requirement of receiving Lu177 is that chemotherapy (docetaxel) has already been given to the patient? A PSMA PET/CT has been carried out last week but we would need to travel from the UK to Germany/Berlin if we were to get the treatment. Many thanks

tango65
tango65
in reply to Jenbt

I had the treatment with a cancer that was hormone sensitive. I did not have chemotherapy treatment before the Lu 177 PSMA treatment. I believe chemmtherapy is not s requirement anymore, but it may be different in different centers.

Drgucancer
Drgucancer
in reply to Flydoggy

There is a study at Cornell and Omaha using LU177 for 1 dose in patients with PSA rising only (no mets) but need to have PSA rising on hormone shot to qualify. Otherwise yes you would have to wait until metastatic. Options for you depending on the rate your PSA is rising. 1) Watch with no treatment safely if rising very slow. 2) Start intermittent hormones (stop once PSA undetectable for 9 months and resume hormones when significant rise usually 1-3 yrs later and repeat); 3) anti androgen therapy alone (casodex or xtandi) controls cancer without lowering testosterone ; more sensitive PET scan ( ie C11 or PSMA) and resect residual disease if minimal.; 4) a clinical trial such as a vaccine Pfizer has a VBIR ( vaccine base immune regimen) should be opening another cohort soon for rising PSA prior to hormones after surgery or radiation failures.

Are you confusing that this is a criteria to be accepted into the US study? We aren't waiting and planning to go to Germany.

I'm 71, and Lucrin ADT plus abiraterone failed ealier this year and I am now on Docetaxel.

Psa is 12, with No 2 chemo infusion in 10 days. I have countless bone mets, all small, and I can still ride a bicycle and work in my shed on craft work.

But if the Psa does not decline with Docetaxel, I will try to get Lu177, available near me in Sydney for about aud $40,000 for 4 infusions. But it does not work always with bone mets, even if the bone mets are generating PsMa which is needed for Lu177 to work.

I might have radium223, ie, Xofigo, as well. If nothing works, I have to just die.

The Docetaxel works by killing fast dividing cells, soit can work with some cancers. But afaik, my Pca is slow growing and cells divide slowly, so I won't be surprised if it does not work, and Psa stsays constant, or rises. I can have 10 infusions of chemo but that is goin to cause bad side effects, so its maybe better for me to have Lu177 if the Psa remains the same or rises after 3 chemo infusions. Lu177 causes side effects, the severity varies between patients, but you can get dry mouth from no saliva and dry eyes from no tears.

So ya have to use replacement fluids for these things.

My first chemo was 2 .5 weeks ago and already my hair is beginning to fall out. Toe and finger nails will also depart. I still have lots of energy and no tiredness.

But bowels are affected by chemo - you can get constipation, or diarea, so some added things are needed to regulate the flow of food and in my case I had EBRT as primary treatment so my bowels are already weakened and the chemo does them no favours.

Maybe

I recall the Germans were first with Lu177 treatments. Many are now seeking it because they have become end-stage patients and there is NOTHING else. My Psa is now low at 12, and maybe the Lu177 will have better result for me than for someone with Psa 1,200.

Patrick T.

Hi Pat

Scrub your nails - and keep them hygienic. My fingernails became infected one by one and I surmise it was because I, as I good club member sanded all my divots using my hands rather than a scoop. My toenails coped much better I fact the fungal growth on my big toes has almost gone. One year after chemo.

Chalkie

Hi Patrick,

Look to my bio for complete treatment history. During Docetaxel chemo I iced my hands and feet and no nail problems and minimal peripheral neuropathy.

Med Onc suggested daily oral B6 to minimize peripheral neuropathy.

I also took Wisconsin American ginseng to moderate fatigue. Google Mayo Clinic for their trial results.

Best wishes. Never Give In.

Mark, Atlanta

Well, I ain't no givver inner, but at hospital I saw nobody getting chemo with ice buckets and freeze hats. My hair ain't worth avvin, its ugly short cropped and being hairless don't worry me. Having no nails might change finger function a bit. But maybe i'll cope, but the far bigger worry is if the chemo does not work, and I have to get Lu177 and maybe Ra223 and all that is most likely to not extend life more than a year or two.

The probable more common problem can be the unpredictable complications caused by all this treatment, and you only need one little thing to give a lot of trouble and life soon becomes a PIA.

Peter Mac hospital in Melbourne have done some Lu177 trials and confirmed more than 50% had Psa reductions. The German study showed mean life extension was 13 months. Probably, if your Psa is 1,200 and you have Lu177, then maybe life extension is less than if Psa = 12.0 which is about where mine is.

It all depends a bit on how well the Pca cells absorb the Lu177 or Ra223, and of course usually there are always survivor cells so that after a year or more you have Psa rise, and the survivor cells don't make PsMa so they don't attract thre isotopes so the treatment is useless, and that's the time to admit there's SFA that can be done.

The trial at Peter Mac 2 years ago showed some guys did not respond at all to Lu177.

We get to a certain age, and we all become a CD, ( a coffin dodger ) and the rich and the poor all cannot escape the inevitable.

Patrick T.

Patrick you do have other options available if your not ready to through in the towel. Taxotere is probably to toughest of them to tolerate. The other chemothery Jevtana seems to be easier to tolerate for most men and no hair loss. Still every 3 weeks. I have also used zytiga +xtandi combination in men with success after clearly failing both separately . One gentleman with gleason 8 was controlled for 4 years after already failing each especially after having Taxotere which may resensitize the cancer to the hormones. I would also genetically test for a dna repair mutation such as BRCA or ATM if postitive u could benefit from a pill parp inhibitor. I have also had remarkable results in some men with no options left receiving Opdivo or keytruda ( one 83yo man gleason 10 no standard options left psa 6,500 dropped to 20 on opdivo and stayed down for over 18 months). There are other radiopharm agents coming soon: thorium and actinium. Xofigo can be beneficial also. Dont rely heavily on PSA as guide for results can be misleading . Example treated over 700 doses of xofigo and 75% had psa rises during the treatments but more importantly had improvement in symptoms and on scans. Other new classes of drugs are out there such as and EZH2 inhibitor and better immune therapies. Happy to give more input if u ever want it.

Jevtana is cabizataxel, and is a next chemo that is available here when Docetaxel fails; Doc said it would, just a matter of time, so once the failure becomes evident, Psa rising, then Lu177 is available in about 6 weeks after that. I think Ra223 is also available, and I could easily blow $120,000, becauxe here in Oz, Medicare does not yet cover cost.

I doubt I'd be allowed to take both abiraterone + enzalutamide together after chemo failure, and probably cost is not covered by Medicare, which covers only a fairly conservative list of possible consecutive treatments.

I look better now with less hair. Hair I had was tight crew cut, and how I look does not matter a bit because I ain't a vain silly man of 71 who expects to ever attract attention from any woman ever again, other than my sister and all the medicos.

The people I like all look past the looks of anyone they meet and are more interested in what is beneath the surface.

Once the Pca is in bones, and I have mainly many bone mets, Psa means less, sure, and progress depends more on comparing scans showing size of bone lesions.

My fight ain't over yet, but I cannot ever assume there's a cure justaround the corner.

Xofigo isn't in Oz yet, ( afaik ) and had huge failure rate, but some guys have had remission after getting it soon after it became available. Chemo lowers white blood cells, my WBC count went from 4.0 to 0.17 after first chemo, so there would be not much for Xofigo treatment to work with.

No other immune therapy is available or has been approved. Its all still experimental,

but at Marsden Hospital in UK, cases of Pca where cells mutated fast thus becoming impossible to treat with usual ADT, RT, chemo, some fellows got remissions, and the beauty of immune therapy is that for thosde where it does work, maybe 15% of patients so far, it may keep working for years; the immune cells with ability to recognize Pca cells as the enemy keep on reproducing.

Just about all other things only work while the active ingredient is in your body, and nobody can withstand having a dose of chemo each week.

You can email me privately if you want. The rules here may stop me typing my email address in, but I could include in a direct reply here so we don't have to go through the group. My website has my email, see turneraudio.au

Patrick Turner.

Excel Diagnostics (Dr. Ebrahim Delpassands) in Houston is conducting a clinical trial of Lu-177. I asked my MO about getting the scan when my PSA was rising at Excel about 2 years ago because they are one of the early adopter of Ga-68 PSMA scan, but I have not followed through. Lu-177 needs Ga68 scan confirmation before getting it.

Win-Pir
Win-Pir
in reply to Cmdrdata

Can you send as much info as possible on you Lutetium trial.Thank you.

We have several patients on Lu-177 trials right now. You are welcome to contact us for more information Urology Cancer Center, Omaha, NE gucancer.com

My father is one of the patients on this trial. Awaiting his first treatment..

Is available in Germany Europe and Australia and possibly India. Can try Bad Berka or Theranostics Australia (theranostics.com.au). Good luck.

whatsinaname
whatsinaname
in reply to NBonL

Yes, the Lu-177-PSMA-617 treatment is available in Bombay, India.

Cheerr
Cheerr
in reply to whatsinaname

Hi whatsinaname,

Is it available across India or just in Bombay? Would like to know if you have any info on where all the Lu-177-PSMA-617 is available considering not all hospitals have it.

I also wish you success in your ongoing treatments.

Best,

Cher

whatsinaname
whatsinaname
in reply to Cheerr

Hi Cher,

The Lu-177 treatment is also available in Gurugram (Haryana) and Bangalore. Since, it is available in Bombay (my home city), I decided to get treated in Bombay w/o bothering too much about the other cities.

Thank you for your good wishes.

Hi whatsinaname,

Can you please tell me how much did it cost you INR. Fellow India here.

The actual treatment cost me INR 275,000/- at Jaslok Hospital.

However, overall, including blood tests, scans, etc, etc, it worked

out to INR 3,50,000/- per treatment.

I took 2 treatments. Nearly succeeded in killing me :-(

I would NEVER EVER recommend it to anyone else.

Hi, Can you advise side effects and has it been successful besides your bad responce?

Thanks

Its available on clinical trial at Urology Cancer Center in Omaha NE but need to have had progression on at least Zytiga or Xtandi and had at least 2doses of docetaxel(Taxotere). There will be other clinical trials coming soon with newer radiopharm agents Thorium and Actinium. I hope this helps!

mjbach
mjbach
in reply to Drgucancer

Is there any way around the taxane/chemo requirement?

Drgucancer
Drgucancer
in reply to mjbach

Not on this study with Endocyte. There is no way around the chemotherapy but only need a minimum of two cycles if you don’t tolerate it. I would also say it is not unusual that the PSA may rise for 2-4 cycles before response seen so don’t get discourage initially if see PSA rise. The Taxotere can be dose modified and unless you had really poor performance status you would likely tolerate it better than ud think. I realize not a walk in the park. But many patients realize improvement in their symptoms from the cancer . Common side effects : fatigue (most prevalent) starts about 2 days after dose and lasts typically 3-4 days, neuropathy (pins needles in fingers toes possible), may lose hair but not everyone does, mild nausea vomiting for most if any, constipation for a day, foods tend to taste metallic ( some people change to plastic silverware to help). Dose is standard 75mg/m2 every 3 weeks. But for better tolerance could start at lower dose. Back in the day before we had many of the newer treatments we used to rely more heavily on Taxotere. I had one patient receive 55 doses. The oldest person I treated with Taxotere was near 90 yrs old. I hope this helps!

mjbach
mjbach
in reply to Drgucancer

Yes knowing a 90 year old has been a patient definitely encouraging for my 75 year old husband. Would love to have him around at 90 as long as he has good QOL. Thanks.

Hidden
Hidden
in reply to Drgucancer

Can you take radium 223 for Mets and Abireterone at the same time?

My father is looking at Germany for Lut. He has many Mets on his spine and shoulder area and his lymph’s have shrunk on traditional chemo. His PSA is about 310 he is 77.

He has had the PET done in Germany and knows he is a candidate for treatment. Is there any reason not to try it?

Thank you for all the information I have contacted Heidelberg for Lutetium 177 treatment consideration , I just need my Oncologist to send on current information. I have heard that radium 223 is an option available if the Abireterone fails, I have had to stop taking this due to a high level of ADT in Liver function that has now settled down so I can commence dosage again but if a bounce occurs in liver again I will have to stop.

Can anyone confirm if Radium 223 is preferable to lutetium 177

There are Lu-177 clinical trials taking place now in Houston, Omaha and UCLA. As I have not yet had Chemo I am not eligible for the Trial. Instead, I am traveling to Univ. Heidelberg in September for Lu-177 treatment. You must have a PMSA scan prior to receiving Lu-177.

I obtain the scan at UCLA.

The liver function tests elevated would either be ur AST or ALT . You could lower dose of abiraterone (2-3) pills a day and potentially stay on. Im not sure what else you have had but there are many other options once abiraterone fails. Xofigo is a very good drug well tolerated but only has affect on bone not soft tissue/lymph nodes. Thats approved so will always have in ur back pocket. I would recommend LU177 if u qualify for a trial or have other access to it. Would theoretically treat any prostate cancer expressing PSMA which is most of the Prostate Cancer Cells. Xofigo before LU177 does not exclude you from LU177 study you just need a 6 month wash out period from time completed until eligible for the LU177 study. There are other exciting radiopharm agents coming down the road soon: thorium and actinium

I believe radium treats bone Mets, since my father has lymph nodes and bone we went with Lu-177 in Omaha phase 3 trial.

I forgot to mention i heard actinium 225 is the next best, they are testing it at Heidelberg university. Hopefully soon we have more info available.

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