2nd round of LU177-PSMA Theraphy didn't go as planned. Immunotherapy in Europe for advanced prostate cancer?

[Sandysol]

Hi, my dad has had two rounds of LU177-PSMA Therapy in Heidelberg, Germany. 7th of August and 23rd of October. AFter the first round his PSA level went down and he felt much better after a few weeks. But now after his second round his blood results came back showing that his PSA level among some other test had gotten worse. He is planned for a 3rd round in January, but is it worth taking?

Has anyone of you or someone you know had similar results after two rounds of LU177-PSMA Therapy, first better and than worse?

His doctor here in Sweden doesn't have anything more to offer him, she says he got it in his own hands now as he took the treatment in Germany. So he feel very down now.

Is there any other therapy, tests you can suggest that would be worth trying? He wants to do immunotherapy but they only offer that to malignant melanoma patients here in Sweden. Do you know anywhere else in Europe where he could get immunotherapy? (Very good if the immunotherapy doctor has handled patiend who first have gotten LU177-PSMA Therapy so he knows how to deal with it.)

Anything else you can recommend me to look into for my dads case would be very helpful, as I don't know how to help him get rid of his cancer anymore.

Thanks!

Best Regards

/Sandra

[Fairwind]

Has he done ADT including Zytiga and chemo ? What is his PSA now and what was his Gleason score..

[Sandysol in reply to Fairwind]

Yes he has done all that, Zytiga and chemo already. But the doctor here in Sweden cant offer anything more, so we had to turn to Germany instead. He has never got to know his Gleason score, but I have asked the professor in Heidelburg if they can tell me. Will get back to you with his PSA level once I know, now I only know it went up.

[Sandysol in reply to Sandysol]

PSA went from 252.6 to 218.7 during this two months.

Now the PSA follow-up done in Sweden presents PSA 224. They haven't got back on the Gleason score. Any suggestions? Have you heard of the drug Olaparib?

[gusgold]

Why not just stay with the German Docs and him them these questions

[Sandysol in reply to gusgold]

Yes, that's what we are doing now. Will look deeper into if its possible to have the Ac-225-PSMA-617 next time. Will probably skip to look in any further on immunotherapy.

[Sandysol in reply to Sandysol]

I got this reply:

The post-therapeutic scintigraphy scans done 8.8.18 and 24.10.18, presented „mixed response“; approx. 60% of the metastases decreased, 40% increased. PSA went from 252.6 to 218.7 during this two months.

Now the PSA follow-up done in Sweden presents PSA 224. Thus, we are currently on a „side-step“ and it can be expected that we will soon have resistant tumor.

My recommendation would be to discontinue PSMA-RLT (i.e. to cancel the third appointment because high costs are facing limited benefit.)

If costs are no issue we are willing to offer 3rd cycle, but duration of clinical benefit might be limited to two months of stable disease and normally we would not consider “cost-effective”.

There is a correlation of patients that respond poorly to PSMA-therapy and harboring DNA-mutations making them promising candidates for olaparib; this drug is approved for prostate cancer in the USA but not yet in Europe. Due to non-native-speaker anamnesis we have limited information about potential “gaps” in his patient history. He might also be a candidate for Abiraterone, Enzalutamide, Cabazitaxel,…

[Tall_Allen]

I'm sorry the second round of therapy did not work as hoped. I know German researchers are working on Ac-225-PSMA-617, which may be more effective. What did his latest Ga-68-PSMA-11 PET scan show?

Immunotherapies have so far been disappointing for PC, except for Provenge. But some are doubtful that even Provenge really has a benefit.

[Sandysol in reply to Tall_Allen]

I've sent mail to Heidelburg to see if any professor there offer the Ac-225-PSMA-617, and if my dad can have that the next time. Thanks for your input about immunotherapy as well. I have also asked how his last Ga-68-PSMA-11 PET scan looked like, so will get back to you once I know. Thanks! Very much appreciated!

[Sandysol in reply to Sandysol]

I got this reply from the professor at Heidelburg:

The post-therapeutic scintigraphy scans done 8.8.18 and 24.10.18, presented „mixed response“; approx. 60% of the metastases decreased, 40% increased. PSA went from 252.6 to 218.7 during this two months.

Now the PSA follow-up done in Sweden presents PSA 224. Thus, we are currently on a „side-step“ and it can be expected that we will soon have resistant tumor.

My recommendation would be to discontinue PSMA-RLT (i.e. to cancel the third appointment because high costs are facing limited benefit.)

If costs are no issue we are willing to offer 3rd cycle, but duration of clinical benefit might be limited to two months of stable disease and normally we would not consider “cost-effective”.

There is a correlation of patients that respond poorly to PSMA-therapy and harboring DNA-mutations making them promising candidates for olaparib; this drug is approved for prostate cancer in the USA but not yet in Europe. Due to non-native-speaker anamnesis we have limited information about potential “gaps” in his patient history. He might also be a candidate for Abiraterone, Enzalutamide, Cabazitaxel,…

ANY SUGGESTIONS ON THAT REPLY? Do you know anything about Olaparib?

[arete1105]

Check out a book by Andrew Scholberg- German Cancer Breakthrough- a Guide to Top Clinics

[Gertgert]

I know someone who had lutitium177 and his psa went down after first treatment then up after second then down after third then up again after fourth. His psma scan showed dramatic improvement after treatment. Doctor indicated psma scan better indicator than psa test. You should ask German doctor his thoughts on doing another scan vs psa blood test.

[Sandysol in reply to Gertgert]

Thank you. I will write them again and see if they can ask for a second scan here in Sweden. Very much appreciated, thanks!

[CalBear74]

If your father is open to natural supplements, I would suggest he consider IP6, aka "phytate" or "phytic acid". Amazon sells AKM Shamsuddin's text on "IP6 7 Inositol". Read this book to understand the biochemistry and immunology that supports its efficacy.

Go to my previous posts and you will find one with Dr. Shamsuddin's name in the title of the post. Review that information and then view these short videos.

Please understand I am not a physician and I recommend only as a 3 year user of IP6.

With your dad, if you choose to proceed, I would suggest a mega-dosing schedule given the mets. This involves six scoops of IP6 powder mixed in water in the AM on an empty stomach (water nothing else). He can eat one hour later. Repeat in the early evening on an empty stomach. I use Enzymatic Therapy's Cell Forte IP6 & Inositol. I am sorry, I don't know what is available in Sweden. The formula should be a blend of inositol hexaphosphate and inositol. There are a couple of competitors of similar quality. Enzymatic Therapy's Cell Forte is the most cost effective in the U.S.

These videos may be helpful:

nutritionfacts.org/video/ph...

nutritionfacts.org/video/ph...

nutritionfacts.org/video/ph...

nutritionfacts.org/video/ho...

For the text,

amazon.com/IP6-Inositol-Nat... 04QOB71W/ref=sr_1_2?ie=UTF8&qid=1543501903&sr=8-2&keywords=shamsuddin+ip6

Jag ska be för din far.

CalBear74

[Sandysol]

I got this reply from the professor at Heidelburg:

The post-therapeutic scintigraphy scans done 8.8.18 and 24.10.18, presented „mixed response“; approx. 60% of the metastases decreased, 40% increased. PSA went from 252.6 to 218.7 during this two months.

Now the PSA follow-up done in Sweden presents PSA 224. Thus, we are currently on a „side-step“ and it can be expected that we will soon have resistant tumor.

My recommendation would be to discontinue PSMA-RLT (i.e. to cancel the third appointment because high costs are facing limited benefit.)

If costs are no issue we are willing to offer 3rd cycle, but duration of clinical benefit might be limited to two months of stable disease and normally we would not consider “cost-effective”.

There is a correlation of patients that respond poorly to PSMA-therapy and harboring DNA-mutations making them promising candidates for olaparib; this drug is approved for prostate cancer in the USA but not yet in Europe. Due to non-native-speaker anamnesis we have limited information about potential “gaps” in his patient history. He might also be a candidate for Abiraterone, Enzalutamide, Cabazitaxel,…

ANY SUGGESTIONS ON THAT REPLY?

[The_Don5 in reply to Sandysol]

Personally i would hit a third cycle if you can afford. But thats just me.... how did it all unfold did you manage to get olaparib?