ChemoRx vs Lu177

[Rexwaterbury]

I am at a crossroad here. Recently became castrate resistant in March. Went on an immunotherapeutic clinical trial recommended by Dr Drake on April 8. Evaluation today shows progression of my lymph node Mets and slight increase in my L2 met. More concerning is my PSADT of 1 month since the clinical trial began. (4.5 to 9 to 18). I was floored. So my options now are to continue with the trial to see if I get a delayed immunotherapy response vs switching to another therapy. I guess the most reasonable alternative options at this time are chemo vs Lu177 (or Ac225). Would appreciate anyone’s opinion before I discuss with Dr. Drake.

Thanks.

[cesanon]

Lu177 is apparently a bit safer than ac225.

There are also chemotherapy options.

Also there is Bipolar androgen therapy that can reset the castrate resistance.

[Hidden]

Have you been on either of the two second-line ADT drugs: Zytiga or Xtandi?

[tango65]

It is not the standard of care but Lu 177 PSMA may be the first option if it is possible to get the treatment in Europe or Australia. If the treatment works, you could delay starting chemo and the new antiandrogens for some time.

I am in a similar situation, becoming castration resistant. Had a Ga68 PSMA with PSA 0.4 and it was negative. They will repeat the Ga 68 PSMA when PSA is around 1. If the are metastases the options are direct therapy or Lu 177 PSMA treatments. I consulted about this plan with Dr. Morris at the MSKCC and he agreed it was a good plan which could delay the use of chemo and new drugs for a couple of years. Perhaps, Lu 177 PSMA treatment could be more effective when used earlier in the cancer progression. I had Lu 177 PSMA treatment in 2016 when the cancer was hormone sensitive (less PSMA expression) with multiple lymph nodes metastases. One treatment with Lu 177 PSMA cleared all the metastases.

[GP24 in reply to tango65]

One treatment with Lu 177 PSMA cleared all the metastases.

I had the same result:

healthunlocked.com/advanced...

Here is a slide which Prof. Baum presented early last year:

pbs.twimg.com/media/DbRYCCE...

This shows the results of treating hormone-sensitive patients with Lu177. Median progression free survival 30.9 months. Comparable to tango65 who is becoming resistant about three years after his treatment. But maybe he is not becoming resistant and his PSA value just rises because he stopped ADT last year.

[Rexwaterbury in reply to GP24]

Where did you and others have your treatment if you don’t mind?

[GP24 in reply to Rexwaterbury]

Tango65 mentioned he had the treatment in Munich, I had it at Bad Berka, Germany. Please read my thread for details. If you use Lu177 with treatment-naive patients, excellent results were observed. However, usually patients will do it after they had a lot of treatments. Then you will not get rid of your mets in one cycle.

[Rexwaterbury]

I have failed both xtandi and zytiga.

[tango65 in reply to Rexwaterbury]

If you had xtandi and zytiga you may qualify for the clinical trials for Lu 177 PSMA treatment,

clinicaltrials.gov/ct2/resu...

or the Ac 225 PSMA treatment at Cornell:

clinicaltrials.gov/ct2/resu...

[The_Don5 in reply to Rexwaterbury]

interesting you were given both of the above. In uk the believe is that resistance to one will result in resistance to another which will produce another month or so of effect if one follows other?

[Fairwind]

Hi Rex..Are the Lu-177 and Ac225 available to you? The Ac225 might work a little better but in many cases it destroys your salivary glands leaving you with permanent "dry mouth" which is not a small issue..

Have you had recent scans (bone and PET/CT) to map out where your mets are if any ?

[Rexwaterbury in reply to Fairwind]

I have pelvic and retroperitoneal Mets. I have a spot on L2 and possibly on a right 10th rib. Had ct and bone scan today. Both showed slight progression. Dr Drake thinks it is a relatively small amount of disease. Seems like a lot to me.

[Hidden in reply to Rexwaterbury]

There is also Radium 223 (Xofigo). It will only work on the bone mets though.

[The_Don5 in reply to Hidden]

and only viable if you have no organ mets or haven't had any?

[Hidden in reply to The_Don5]

As far as I know, it's only if you currently have them. In the clinical trial for approval, they only took patients with no visceral mets. It would still work in the bones, it's just not approved for that indication.

[Tall_Allen]

Suggest you consult with Scott Tagawa at Weill Cornell.

[wrando in reply to Tall_Allen]

He's my guy...nice man, good sense of humor.

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

If he has a good sense of humor, then he's my guy too...

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 05/23/2019 4:41 PM DST

[The_Don5 in reply to j-o-h-n]

speaking of which our MO told a joke the other week....

guy goes in for treatment.. says "doc can i play the piano after chemo?", MO says "sure you can"... guy says "thats something because i couldn't before".....

[j-o-h-n in reply to The_Don5]

Cute but no knee slapper... Thank you, I love all the humor I can get...

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 05/29/2019 5:22 PM DST

[The_Don5 in reply to j-o-h-n]

your a hard man to make laugh John, I'll tell the Mo to up his game.

[j-o-h-n in reply to The_Don5]

For your MO's eyes only:

So a doctor informs a Man that he's not sure if the Man's Wife has Alzheimer's disease or Aids.

Man say's "what should I do doctor?

Doctor replies "Send your Wife out for a long walk if she comes back don't fxxk her".

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 05/30/2019 4:10 PM DST

[spm58]

Hi Rex I too. Am on a trial at md Anderson. It’s called DynaMo. Started on lupron, zytega and apalutamide( non fda approved) and has worked great for me. Now I have to do immunotherapy cause computer says so. I’m worried about that. What hospital are you at and ask your dr about those drugs.