Ac225-minimzing side effects

[Fuzzman77]

Hi all. I will be leaving for Delhi to get a new batch of APCEDEN vaccines made for me and my first Ac225 infusion September 5th. Anyone here have Ac225 and if so did you end up with dry mouth. My main question is there anything at all preemptive I can do to minimize the risk of dry mouth. I only have the cancer left in the prostate as the APCEDEN and Xtandi together keep my PSA around 2 from a start of 212 five years ago. I'm hoping that with less of a tumor burden the side effects may not be so bad. And if you did get dry mouth from Ac225 did it go away or get better over time?

[GP24]

What you can try to do is to cause the salivary glands to produce lots of salvia during treatment to wash out the substance. Chewing gum or lemon drops or lemon juice will do. If you get a dry mouth it will get better over time but may not go away any more after several cycles of Ac225. Cherry tomatoes will help then. Today they often give you a Lu177/Ac225 mix to avoid affecting the salivary glands too much.

It seems that the side effects increase with lower tumor burden because the ligands find fewer PCa cells to attach to. They attach to healthy cells then instead.

Prostate radiation would also decrease the tumor burden a lot.

[whatsinaname in reply to GP24]

Excellent post, GP24, thank you very much.

I hope Chris reads this.

[Fuzzman77 in reply to whatsinaname]

I read it and am hoping Tall_Allan comments on the new ligand they are working on that spares the kidneys and avoids xerostomia(dry mouth). I am stable for 2 years now so have some time to decide.

[whatsinaname in reply to Fuzzman77]

All the very best, Chris.

[Cheerr]

Goodluck with the Ac225 treatment

[MateoBeach]

Additionally external cooling packs over the cheeks (parotid glands) decreases PSMA binding (just a little though). Not established but perhaps sublingual ice chips might similarly help with the sublingual glands. Here is this:

Impact of external cooling with icepacks on 68Ga-PSMA uptake in salivary glands

Ludwike W M van Kalmthout, M G E H Lam, +4 authors Arthur J A T BraatPublished in EJNMMI Research 2018

DOI:10.1186/s13550-018-0408-2

BackgroundExternal cooling of the salivary glands is advised to prevent xerostomia in lutetium-177-PSMA treatment for advanced prostate cancer. Since evidence addressing this subject is sparse, this study aims to determine impact of icepacks application on uptake in salivary glands. Eighty-nine patients referred for gallium-68-PSMA PET/CT for (re)staging of prostate cancer were prospectively included. Twenty-four patients were scanned with unilateral (solely left-sided) icepacks; 20 with bilateral icepacks; 45 without icepacks. Icepacks were applied approximately 30 minutes prior to tracer injection. PET/CT acquisition started 1 hour postinjection. Radiotracer uptake was measured in the parotid- and submandibular glands.ResultsWhen comparing the intervention group with the control group, uptake in the left parotid gland significantly differed: SUVmax: 11.07 ± 3.53 versus 12.95 ± 4.16; p = 0.02. SUVpeak: 9.91 ± 3.14 versus 11.45 ± 3.61; p = 0.04. SUVmax and SUVpeak were reduced with 14.52% and 13.45%. All other SUV values did not significantly differ. Patients with bilateral icepacks showed no significant differences in PSMA uptake compared to the control group (all: p > 0.05). Intra-patient analysis revealed some significant differences in SUVmax and SUVpeak between the cooled and non-cooled parotid gland (SUVmax: 11.12 ± 3.71 versus 12.69 ± 3.75; p = 0.00. SUVpeak: 9.93 ± 3.32 versus 11.25 ± 3.25; p = 0.00).ConclusionsImpact of icepacks on PSMA uptake seems to be limited to the parotid glands. As clinical relevance of these findings is debatable, structural application of icepacks in the setting of lutetium-177 PSMA therapy needs careful consideration.