VISION trial confusion.

[JimBarringer]

Question for those on VISION trial. I’ve had two infusions now. After first infusion PSA dropped from 375 to 105. Very excited about these results but then my CT scan and bone scan taken last week indicated cancer progression in bone Mets, new Mets on spine but some reduction in lymph node activity. Are these seemingly conflicting results normal. Thanks for your experiences. Jim

[AlanMeyer]

I have no expertise in this area. All I can do is throw out a few ideas that others may be able to comment on or that you may be able to take to your oncologist.

Conceivably, you had a lot more PSMA (and cancer) in soft tissue than in bones. If so, then your response to the Lu-177 treatment was a net positive for you because it reduced your total PSA (and presumably your total cancer) to only 28% of what it was, but nothing much happened in the bones.

Fortunately, there is another injectable radiation treatment, Xofigo (Radium-233) which does nothing for soft tissue, but works against cancer in the bones. If so, you might be able to administer a one-two punch with the Lu-177 and the Ra-233. In the past you would only have been able to do the Ra-233. And of course in the deeper past (before 2013) you wouldn't have had that drug available either.

I hope the Lu-177 really cleaned out the soft tissue mets for you.

Best of luck.

Alan

[JimBarringer in reply to AlanMeyer]

Thank you AlanMeyer, your observations and advice are always informative. In this case they are also encouraging.

The future is brighter than the past. Heck I’ve failed plenty of drugs and treatment options that weren’t even available when first diagnosed.

[Metungboy in reply to JimBarringer]

Correction, The drugs have failed you.

[JimBarringer in reply to Metungboy]

I like that. I’ve used them up, taken what they had available to help me then tossed them to the side of the road when they no longer did anything for me. Next!

[cesces in reply to AlanMeyer]

What about the act225 psma? Might that be an option?

[AlanMeyer in reply to cesces]

I would expect the Actinium-225 to have about the same effect as the Lutetium-177. Although they are different radioactive isotopes, they are both bonded to an antibody to PSMA and should therefore be active in the same places - namely tumor cells that have PSMA on their cell surfaces (i.e., "membranes").

Alan

[cesces in reply to AlanMeyer]

Yes, that makes sense.

Though they each use different radiation.

Act-225 uses the same radiation as the Bayer treatment ra 232.

[AlanMeyer in reply to cesces]

Basically right, Ac-225 and Ra-223 both emit alpha particles during their radioactive decay.

[AlanMeyer]

And of course it's also possible that a second and subsequent Lu-177 treatment will have a significant effect, possibly also in the bones. I am guardedly optimistic about your situation for some time ahead.

Alan

[Fairwind]

I too have just finished my second dose of Lu-177 and my PSA dropped from 2300 to 730, a 65% reduction after the 1st dose. My scans also showed no improvement in bone mets but CT scan showed no soft tissue mets. My mets have been confined to my bones since day one..I'm thinking the bone mets will take a while to die and improvements in bone scans might be slow in coming..The radiation does not kill the cancer instantly...

[JimBarringer]

Thank you Fairwind. Sounds encouraging. I haven’t had a chance to speak to my oncologist at OHSU about these results. Have you spoken with yours yet and if so, were they unconcerned about the scans? If these results were expected I sure would have liked to be forewarned.

[GP24]

In Germany and other countries they use Act-225 or a combination of Act-225 and Lu177 if the patient has bone mets. Act-225 seems to be more beneficial against bone mets than Lu177.

Maybe you can take part in a trial like this one, after the VISION trial:

clinicaltrials.gov/ct2/show...

[Fairwind in reply to GP24]

"Brief Summary:

This is an open−label, single−center Phase I dose escalation study designed to determine the dose−limiting toxicity (DLT) and the maximum tolerated dose (MTD) of 225Ac−J591 in a single dose regimen."

At the moment, you might be better off trying R-223, an approved treatment that works well on bone mets. I would give the Lu-177 a little more time especially if your PSA keeps dropping in a dramatic fashion...

[GP24 in reply to Fairwind]

I wrote "in a trial like this one" assuming that this trial will be followed by a phase II trial and maybe similar trials.

[noirhole]

From what I have read 225-AC targets PSMA and could leave you with permanent damage to your salivary glands. I would be wary of dose escalation at least until they have more data.

[cesces in reply to noirhole]

And kidneys. Good point.

[Patrick-Turner]

Alan Meyer states what I also think happens with Lu177, because I had 4 shots 8 weeks apart after Nov 4 in 2018. Psa was 25. I had countless mets, but all not very big, largest in bones was about size of a pea.

After No1 Lu177, Psa stayed at 25. After no2 Lu177, Psa just begun to drop and was 17. Doctor had some doubt it was working, but PsMa scan showed considerable reduction of soft tissue mets.

Then Xtandi added after No3, and after No4, Psa went to 1.7.

The later PsMa scan after all treatment was done showed all soft tissue mets not showing, and bone mets were not increasing but healing, and no new bone mets. That was in about June, but now Psa is 0.4, and falling, and all mets were slightly PsMa avid and falling as Pca died. CT part of PsMa scan showed nothing that was not also in PET part of scan, so it seems I have only one type of Pca, the slow growing one without variations. So it seems I have got a remarkably good result. Don't give up on Lu177 yet. Keep going.

Latest research by Professor Hoffman at Peter Mac in Melbourne shows that if Psa rises again in months ahead, getting more Lu177 is likely to work again and many have got 40months extension to OS, ie, over 3 years. By that time, hopefully more therapies may become available.

However, if Pca produces Psa, but not PsMa avidity, Lu177 won't work so some other treatment is needed. My suppliers of Lu177 treatment give betterment to 70% of those they treat, and all must have sufficient PsMa avidity shown in PsMa scans before any treatment. See Theranostics Australia website.

Patrick Turner.

[CJ4J]

My husband just completed the vision trial. I would ask for a petscan to have a better picture of what's going on. After his 2nd treatment, bonescan showed some activity but 2 weeks after that choline petscan showed all resolved. Give it sometime for healing.

[Jackpine]

Jim,

I would also give it some time. I did 6 cycles of LU177 PSMA and. It resolved both my soft tissue and bone Mets. I went from hundreds of bone Mets to 2 which we just treated with SBRT.

[JimBarringer in reply to Jackpine]

Thanks Jack. My anxiety is calmed. I’ll let it run it’s course before worrying about things that don’t need to be worried about.

[drfabio]

Hi Jim,

Sometimes we see a flair on the CT and bone scan in response to treatment. The PSA, Alk Phos, LDH will be better interim markers to follow, and your initial drop in PSA is great. So going forward with the additional cycles will likely be prudent, and the direction this is going should become more evident down the line.

Yours in Health

--Fabio

drfabio.com

[immunity1]

Jim, I would not panic (as my oncologist says!). After my 4 cycles of Lu177 it took up to 12 months following that for 6/7 of my lesions to disappear even though PSA disappeared at the time of my 4th cycle. Having said that, my lesions were all soft tissue. I would stick with the programme, especially if it is free! Rob.

[JimBarringer in reply to immunity1]

Thanks Rob, and free is a good thing.

[Casper3]

Hi Jim, this isn’t a reply to your inquiry but I am interested in how you are getting the lu177. If you were part of the trial how do you know your getting it? I’m sorry if I’m asking this in the wrong place but I’m new to this site.