Xtandi with lutetium?

[Jenbt]

We are booked for first session of lutetium 24th of this month with Technical uni Munich they had a date sooner than h/berg . The assistant prof Matthias eiber has dealt with us all along and has been excellent .however today he informed us Dad would have to come off Xtandi whilst receiving lutetium ? Matthias stated that interactions between the two regimes are still not known. They would not recommend combination, butcannot refrain a patient by doing so. Has anyone else taken both at the same time? Or are there any studies to show safety and effectiveness of both together? Thanks

[GP24]

What do you prefer - continue Xtandi or not?

"Matthias stated that interactions between the two regimes are still not known." Dr. Eiber is right, it is unknown. However, studies with mice have shown, that Xtandi increases the PSMA expression and therefore should support the Lu177 therapy. Other clinics recommend to use Xtandi with Lu177 for that reason. There have been no studies with humans, however.

They could not refrain me from doing so. I used Bicalutamide to increase the PSMA expression. This will not increase as much as Xtandi though. At Bad Berka they asked me to use Xtandi instead, but my health insurance will not pay for that.

[tango65]

As far as I know there is not information indicating that Lu 177 PSMA treatment is associated with complications when the treated patients are taking enzalutamide or abiraterone. There is information indicating that abiraterone +prednisone and xofigo treatment (Radium 223) is associated with higher mortality and bone fractures. Perhaps Dr. Eibert is being cautious because of the problems encountered when Xofigo was administered in patients taking abiraterone.

[Tall_Allen]

Sometimes anti-androgens,like Xtandi, increase the PSMA avidity of tumors. Maybe that increase in PSMA makes lutetium less apt to kill the cell? Maybe not? Is that a gamble you are willing to take? If you are prudent, you would follow his directions.

[aantiqueman]

Would you kindly give me the name and email address of your contact at TUM. I need to request treatment for my metastatic bone disease. Thank you.

[j-o-h-n in reply to aantiqueman]

You should post a separate request for information. Include

age, location, treatment(s) so far, your treatment center, doctor(s) names. Your PDA score and Gleason score and any pertinent info you need to tell us. All info is voluntary but it helps us help you and helps us too. Please do not respond to me. Thank you.

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 04/16/2019 5:30 PM DST

[The_Don5 in reply to aantiqueman]

sonja is the person to contact in nuclear medicine i can't recall her second name but will get it for you when return if you email through the international department it will be directed to this lady who will set wheels in motion.

[PhilipSZacarias]

Hello Jenbt, Although enzulatamide (and ADT, abiraterone) increase the expression of PSMA which helps in increasing the effectiveness of imaging and treatment with radionucleoides, trials with abiraterone+prednisone and Ra 223 resulted in an increase in fractures (Higher Risk of Fragility Fractures in Prostate Cancer Patients Treated with Combined Radium-223 and Abiraterone- Prednisone May Be the Culprit. doi.org/10.1016/j.eururo.20... 0302-2838/© 2019 European Association of Urology). The increased fractures were blamed on the prednisone component, nevertheless this experience is making them cautious about combining enzalutamide with lutetium 177. Caution is warranted, but then again many members in this forum take risks. Cheers, Philip

[HopingForTheBest1]

You may want to consider taking the AR-V7 test to check if Xtandi will be effective for you before you start it.

[The_Don5]

jnm.snmjournals.org/content...

Addition of Abiraterone or Enzalutamide provided a significant prolongation of survival (40 months, p<0.05).

wonder why the medics are hesitating?

[The_Don5]

link.springer.com/article/1...

mice though....

Results

Tumor growth was delayed by ARB while 68Ga-PSMA11 uptake increased up to 2.3-fold over time when compared to controls. ABR-induced upregulation of PSMA expression was confirmed by flow cytometry. Phospho-γH2A.X levels increased 1.8- and 3.4-fold at 48 h in response to single treatment ENZ or RLT and ENZ+RLT, respectively. Despite significantly greater DNA damage and persistent increase of PSMA expression at the time of RLT, no additional tumor growth retardation was observed in the ENZ+RLT group (vs. RLT only, p = 0.372 at day 81). Median survival did not improve significantly when ENZ was combined with RLT.

[Tall_Allen]

I replied to you on your other post.