LU treatment in Germany

[TexBill]

The published papers I've seen on Lutetium speak of giving patients four treatments, each six weeks apart. The programs in Germany for Lutetium treatment include a five day inpatient stay. I assume that is only one treatment. Are you supposed to return to Germany every six weeks in order to expect the same results as in the published papers?

[TexBill]

Found my answer. According to the Universitats Klinikum Frankfurt website, normally 2 to 6 treatments are carried out every 2 months.

[tango65]

The doctors at The Technical University f Munich offered me up to 6 treatments depending on the amount of radiation received by the kidneys. The stay in the hospital is only 3 night for each round of Lu 177 PSMA, not 5 days. I was admitted on Friday and I was discharged on Monday after a full body scan and a SPECT scan which are included in the price of the treatment.

[cesanon in reply to tango65]

"depending on the amount of radiation received by the kidneys"

That's the part that bothers me. Kidneys just plain go bad as you age.

They attract the pmsa just like prostate cancer cells.

Life on dialysis is not a good quality of life. I don't know that it is such a good trade-off.

I understand actinium is even worse.

I read there is a better ligand upcoming that may reduce or eliminate this problem.

[tango65 in reply to cesanon]

The kidneys are irradiated but Grade 3 and 4 nephrotoxicity has not been reported in patients treated with Lu 177 PSMA.

ncbi.nlm.nih.gov/pubmed/283...

[cesanon in reply to tango65]

Thanks for the article.

It also said: "In 14 patients (25%), we observed increased creatinine levels of CTC 1° or 2°. There were 16 cases of increased GFR (grade 1/2). At the baseline, only 14 patients had elevated cystatin C. However, post-therapeutic cystatin C was elevated in 32 patients (58%). A significant effect on renal function was found for age (p = 0.049), hypertension (p = 0.001) and pre-existing kidney disease (p = 0.001). The most reliable predictive markers of nephrotoxicity were TER-MAG3 and cystatin C."

I have no clue how to interpret this. It does seem that there are kidney issues. Sufficient enough that they limit the number of treatments because of them.

This causes me great caution.

[GP24]

They give you an infusion with Lu177 and you have to stay in hospital for two days. No visitors during that time so you do not radiate these. The standard is to get a second infusion six to eight weeks later and a PSMA PET/CT about six weeks after that. Then the doctor and you decide whether based on the results of this PSMA PET/CT a further infusion or several further infusions are indicated.

I had lymph nodes only and asked for a PSMA PET/CT six weeks after the first infusion. I had a great response, no lymph node mets could be located any more and I could save myself the second infusion.

They check whether there is any kidney stricture before the infusion. If there is no stricture, you do not have to worry about side effects there.

[whatsinaname in reply to GP24]

As regards my infusion in Bombay (it was an IV infusion, not an injection), it lasted (the actual Lu-177 infusion) approx 20 mins. No pain whatsoever. My wife was allowed in the room immediately after the infusion was completed.

The second infusion is supposed to be 2 months later. And, then every two months depending on the patient.

[whatsinaname in reply to whatsinaname]

Of course, the usual scans and blood tests were taken both before and after the Lu-177 infusion. Renal scan, salivary gland test, kidney function test, average GRF (creatinine), PSA, serum calcium, ionized calcium, potassium test, etc, etc, etc.

I asked the "doctors" about having to stay for 3/5 days in the hospital because of the effects of "radiation" and they told me categorically that the amount of radiation is not sufficient to need that precaution. Soooo, why do they do it in Germany, then ?? Because, the Germans are over cautious and can make more money keeping patients in for 3/5 days instead of just overnight That's what they said