Actinium 225 combined with Zytiga

[Ldb01]

After Docetaxel and Jevtana failed last year, hubby was given Zytiga with Prednisone in December 2018. After researching trials, we had the option to go to USA for Lu-177 or stay in South Africa. We were immediately accepted onto the ACtinium trial here. One shot every 8 weeks, and two gallium scans later. Got results yesterday. Mets in spine, ribs, skull, shoulders are gone ! Tumour above prostate has shrunk. Cancer in pelvic area is much less. One lesion left in femur. Next injection is next week. PSA dropped from 48 in December to 2 this week. We are celebrating because this is the best news in 3 years !

[Hidden]

Great, thanks for the report.

I know this unproven as of yet, but I think ACT-225 should be more effective than LU-177 because ACT-225 it is a much more powerful alpha emitter vs LU-177, a beta emitter. Alpha particles are higher energy, shorter range. They are much more likely to produce double-strand DNA breaks, a death sentence for the cancer they hit.

I do think ACT-225 will prove to be the more effective of the two, and right now it's available for a much lower price than LU-177 in South Africa. I was thinking that if I was in the situation where I needed it now, I would go down there for the treatment. Please keep us posted on the progress.

Wishing you the best.

[whatsinaname in reply to Hidden]

Apparently, the after effects of ACT-225 are also a lot worse than that of Lu-177. Especially, the salivary gland problems. Any dope on the after effects ??

[Hidden in reply to whatsinaname]

Thanks, I was just reading about that and it makes sense. It's more effective at killing whatever it hits, healthy or not. I think I would want to see how much PSMA expression I had in the salivary glands, some people have less which would help the side effects. I'd like to more learn about that.

[Hidden in reply to whatsinaname]

Here's an article that discusses the problem along with some potential solutions.

jnm.snmjournals.org/content...

[Ldb01 in reply to Hidden]

Gregg57, I willl most definitely do so !

[Ldb01]

Thank you Ssamo. Have you consider dered a trial ?

[Tall_Allen]

Great news. Ac-225-PSMA-617 is great stuff!

[Fairwind in reply to Tall_Allen]

Are there any Clinical trials going on in the U.S. ? Few of us can hop on an airplane, fly to a foreign country and be treated with no insurance...

[Tall_Allen in reply to Fairwind]

Scott Tagawa at Weill Cornell is running a Phase 1 clinical trial of Ac-225-J591 (which may be more specific/less toxic):

clinicaltrials.gov/ct2/show...

I-135-MIP-1095 will begin next month in Canada:

pcnrv.blogspot.com/2018/10/...

Th-227-PSMA will be at MSK but hasn't announced recruiting yet:

pcnrv.blogspot.com/2018/10/...

[Patrick-Turner in reply to Tall_Allen]

Hi Tall Allen, I think you are right, Ac225 does seems better to get Pca reduction in both soft tissues and bones than Lu177, but I read that Ac225 causes much more dry mouth and dry eye side effects. I just finished 4 Lutetium shots and my stubborn Psa was 25 before and its now about 3.5. But Psa was 5 before No 4 Lu177. Docs started me on enzalutamide just after No 3 Lu177, because it was believed it would make the last Lu177 much more effective. So far so good, but then If enzalutamide is effective in reducing Psa by supressing but not killing Pca cells, its effect may mask what the full effect of Lu177 might be.

So I expect enzal might have a suppression time of only months, and then what? But I could then get more Lu177 if Psa rises and the mets show up clearly in future PsMa scans because they have PsMa avidity. It sure ain't over yet. And each PsMa scan is usd $500, no Medicare refund. But enzalutamide, ie, Xtandi, is fully funded by our Medicare, so $6.30 at a chemist each month.

Soft tissue mets to have gone but bone mets were slow to react, but that's typical for Lu177, its a slower acting agent. I won't know if it continues to fall or bounces straight back up until the next Psa test in 3 weeks, and a PsMa scan after that.

Each Lu177 shot is about usd $7,000, and I have had 4 in Sydney. But in above posts someone said Ac225 was more expensive, but then maybe you only need 2 shots to do the same as 4 shots of Lu177.

So far, no dry eye problems and dry mouth was only slight at night during first week after having the last 3 shots, so my body is trying to recover from whatever damage is done. However, radiation therapy effects are a bit unpredictable and sometimes there are acute effects right after RT, but they clear up, but then long term effects begin, so I'd not be surprised if I got dry eyes and mouth say in 6 months or a year from now. I am not sure if Ac225 is available in Australia like the Lu177, as described by Theranostics Australia which is a company licensed to give these things which do not have phase 3 trial success, so no official approval yet, so to get Lu177, I had to have failed chemo, and 3 docs agreed on that one. After failing chemo I was free to buy whatever I liked, maybe ground up extract from a cane toad if I dared.

(( The cane toad is a large horrible poisonous frog brought to Oz in 1930s from Sth America to eat insects in cane plantations. It was a complete failure, and it went feral and bred up ferociously without any predator and any animal that eats a cane toad dies in agony, so a lot of beloved native animals have been hugely reduced in our northern states. No biological control has been found. But I think if my Pca was introduced to a cane toad, the Pca would be automatically stopped. :-))

Its a nice day here, but -2C last night, but will be +20C later.

Winter is near.

Must away to vote for the least obnoxious Polly Tishans in our National Federal elections today.

Patrick Turner.

[Tall_Allen in reply to Patrick-Turner]

I know that in Heidelberg they are combining the two. There's a lot to be learned.

[Patrick-Turner in reply to Tall_Allen]

Indeed, and I don't know if Theranostics Australia is doing that yet, but because Ac225 acts well on all mets both in bones and soft tissues if there is enough PsMa expression by tumours, maybe less doses are needed, and one might not need to have multiple doses of Ra223, ie, radium isotope aka Zofigo which is not dependent on having a ligand because the Ra223 sloshes around the body and slowly goes to replace Calcium at active met sites to kill the mets in bones. Ra is a bit primitive because it probably causes a lot of damage because its not targeted and made to gather at met sites in the same way as having a ligand chemical to make say Lu177 or Ac225, in a chloride solution bind to cancer mets where there blood flow into cancer cells.

[Tall_Allen in reply to Patrick-Turner]

Nevertheless, Xofigo has a good safety record when used earlier. It is primarily picked up in areas of active bone overgrowth. I think you're right that using alpha emitters (like Xofigo or Ac225) are more efficient.

[Patrick-Turner in reply to Tall_Allen]

Well yeah. I might yet get it. I never let Psa get above 50 so far since diagnosis in 2009. And its about 3.5 now. My biggest bone met size is about 10mm dia, or the size of a pea, so no microfractures of bones yet, and if docs think I ought have Ra223, then fine, I might get it. Because I have such small bone mets, the Ra223 would be take less time to kill cancer because there is less of it compared to a man with Psa 300 or 3,000 from his bone mets. There are other things I can try before considering more drastic nuclide radiation. One doc said she thought a couple of mets I had were maybe not expressing much PsMa so the theranostic nuclide treatments may never achieve total cancer killing; my tumors are old, and probably have become variegated so not all of what I have could respond to theranostic treatments. Many men could have this problem. So what kills a man is what has mutated into something that is not able to be killed by anything that docs know of yet. I've seen this happen in other men.

Patrick Turner.

[Peterd110 in reply to Patrick-Turner]

If someone has Ra223, will they still be able to receive Ac235 or Lu177 later on?

[Ldb01 in reply to Patrick-Turner]

I know that some Aussies travelled to South Africa for ACT 225.

[Patrick-Turner in reply to Ldb01]

Yes, I guess there would be a few, and to some, the time and expense is the least of their concerns. At the last shot of Lu177 I had, there were 4 patients, one Oz man and myself and two from USA. But many ppl just cannot afford the Lu177 or any other fancy-smancy cancer treatment that is not offered by the public hospital system, so they all die sooner rather than later.

Patrick Turner.

[16starsky]

Do you have to be CRPC to have this treatment ?

[Bebby1]

Very brave men are you all

I pray you will have success

[CJ4J]

Happy News and Happy Dance for you too 💃🕺🎉

[Hidden]

Congrats!!!!

[Zee5]

Great news - glad to hear! I too am looking at pursuing ACT 225. I first looked at going to Heidelberg, Germany but the costs are super expensive - around 13,000eu per session. Then I came across the trial in South Africa at University of Pretoria with Professor Mike Sathegke, at a fraction of the cost. Is this where you went?

[Ldb01 in reply to Zee5]

Yes. An awesome team and if you can make a combined vacation and come to SA it would probably be worth it. Only thing you have to go every 8 weeks.

[monte1111]

Great news! Two great posts in a row. Keep 'em coming.

[larry_dammit]

Wow that’s great news. 🙏🙏🙏🙏

[larry_dammit]

Had hoped to hear some good news about this med. hate to travel but want to get rid of the Mets Fight that monster