Has anyone heard of any preliminary results from the vision trial? Could those who have had Lu177 please share their own results? I have heard that many who are treated with Lu177 have good and rapid improvement, but perhaps short-lived with fairly rapid progression thereafter.
Trying to get a feel for this treatment as I may soon be facing that decision.
Thanks,
Rex
1. It is not clear to me what mechanism would make LU177 treatment more short lived than others.
2. There are some serious side effect issues with most versions of LU177 treatment. It kills renal and salivary gland cells as well as prostate cancer cells.
If you are older with already depleted kidney functioning, that is not a good thing. And actually non-functioning salivary glands may be even worse than dialysis when it comes to quality of life issues (and maybe also life expectancy issues).
If you ever see LU177 images, you can see it concentrating not only around the prostate cancer tumors, but also around the kidneys and the salivary glands. LU177 is an equally opportunity killer of any cell to which it attaches itself.
3. I believe that there is one version of LU177 treatment that avoids the kidneys and salivary glands, but last time I checked it was just starting clinical trials.
Can you send me the article pertaining to Lu-177 avoiding the salivary glands? Maybe in the usa still in trials but maybe in germany already in use? I sense from your writing you are no in favour of Lu-177? Sorry if i read that sentiment wrong? Pls tell me why. I am making a pro and con list.
1. It is not unlikely that should I become castrate resistant, I would choose LU177 treatment over Chemo because of my depleted CD4 T-Cell levels.
2. I don't recollect where I read this info about lu-177 and salivary glans and kidneys, but at conferences where they have displayed PSMA imaging, it clearly lights up the prostate, salivary gland and the Kidneys.
3. This issue is solely an issue of the type of PSMA ligand that is used to carry the LU-177 particle that emits the radiation. The are several in current use, and there are more coming along the way. One of which is supposed to specifically avoid the kidneys and salivary glands.
If you don't watch out for yourself, the medical system will not. You must stay informed and stay on your toes.
The Docs are particularly poor at informing you about side effects. They generally sort of don't care too much about the comfort issues of their always whiney patients.
You have to own issues like side effects and quality of life issues. If you delegate that to your docs, you will almost certainly suffer for it.
Keep in mind anything powerful enough to do a lot of good, is also likely to be powerful enough to do a lot of bad. Cancer treatment is nothing but a bunch of trade offs. You need to own what those trade offs are.
There is some preliminary data available on the results of LU-177 treatments: Here's two articles:
There are no preliminary results - the first results are not expected until August 2020
But what about the ones abroad, germany the UK, australia..good reports?
Yes, pretty good so far. PSA declines of over 50% in 30-50%. Better than expected survival. Check the links at the bottom of this:
pcnrv.blogspot.com/2017/09/...
Thanks for the info. My brother lives in the netherlands and has access to the latest scanning machines. He qualifies for the Lu-177. I am now researching what combination packet he should ask for to fight the tumors that do not express psma. Are some combinations better than others ? Is there an info on that yet?
Also there seems to be something new on the market that virtually limits the dry mouth side effect. The hospital also suggested another scan before he drives to germany, the FDG PET scan? Have you heard of this and why would they ask for that?
As always thank you so much for all your valuable knowledge you give to all of us.
Cosette
The Germans have more info on Ac-225 combo therapy than anything in the published literature.The FDG scan is because they want to understand the heterogeneity of his tumors- if he kills off only the cells that display PSMA, will the non-PSMA cells take over?
If money and being in europe is not a problem. Is there something that you would look into? We are doing chemo every three weeks, carbo comb. Tolerating this very well. And stabilizing some. No organs involved. But a lot of bone mets, new hip etc. but he is in very good health, works out, eats well. Travels. Eventhough his onc did not think he would be here this coming xmas. He has a very aggressive form apparently. Has had radia for pain.
If the carboplatin is helping, a PARP inhibitor may help too. If he only has bone mets, Xofigo may work as well or better than Lu-177. It would be a good time to do Provenge when he has the radiation.
He might also want to investigate a clinical trial in Finland or the UK of Th-227-PSMA. What is interesting about it, is that Th-227 is a powerful alpha emitter (like Ac-225) that attaches to PSMA-avid cells, and then it decays into Ra-223 and detaches from the PSMA-avid cells. Ra-223 is the active ingredient in Xofigo. It attaches to bone mets, whether they exhibit PSMA or not. So you get two shots at killing the cancer from one injection. The downside is that no one knows anything yet about its toxicity.
pcnrv.blogspot.com/2018/10/...
clinicaltrials.gov/ct2/show...
Provenge whilst doing the LU-177 ?
I suspect they will act synergistically - Provenge will attach to the cancer cells killed by the radiation.
My husband finished his 6th treatment on the vision trial in August this year. He was undetectable after the 5th treatment and has remained undetectable since then. All tumors were resolved and there has been no progression. He had his last petscan in October. They noted patchy marrow or possible new met on the thoracic, which they said not to worry about it as this was probably healing due to bone marrow trying to heal the white cells. He breezed through the treatments with no side effects. We are so very thankful the Lut-177 /Xtandi combo worked for him as he was out of options last year.
CJ4J: In what City did your husband receive treatment?
He got the treatment in Omaha. The vision study is closed now. But i believe they are doing other studies with Lut-177.
Doing well after the third infusion PSA at the lowest since I started at 1.27 and tumors are still shrinking on scans bone metastases stable. Thinking of DNA profiling after treatment or another treatment to get cells that may not be expressing PMSA. Very pleased going into the holidays.
What treatment did you have in mind for the tumors not expression PSMA. I also heard that they are thinking of combining those w the LU-177
Going to have some genetic testing to see if I can target any variants. Then maybe chemo or another trail that maybe suggested by my Duke Cancer Team. Not something I have to worry about until I get closer to March 2020 when the last infusion is scheduled or as long as the current treatment is still working.
I did UCLA trial. Coordinator says most get a response from it, some better than others. They think it will get approved someday. Side effects are a cost with any treatment. This treatment is offered to patients with significant bone mets and/or other mets to try to reduce burden of the disease in a targeted way, and extend life. Alternative is death if you tried everything else. Unfortunately for me, I only got a mild response. Was hoping for more.
Hearing about a lot of people who get a mild response but follow-up later to clean up with SBRT radiation. That is exactly what I am doing now.
"clean up with SBRT" - This is very interesting. I plan to get this done too. Who is the doctor that recommended this treatment and where do you get it done?
My husband had treatment on the Vision trial. Mild response after round 1 after round 2 he had disease progression on his scans and rising PSA. He also had increased lymph node pressing on his kidney which required a stent. He felt very unwell during treatment with weeks of nausea and vomiting. Treatment was discontinued after round 2. We like many others believed that Lu177 was a holy grail and were bitterly disappointed. He has now had first carbazitaxal treatment and we wait to see if there is a response.
So sorry to hear this...such a disappointment. We are getting ready to do this treatment in germany. Where did you have this done? Wishing you hope and good luck in the next phase.
Hello Cosette 100 - we are in the UK and did Vision trial in Bristol- I still believe in this treatment and the treating professor of oncology said he believes that soon it will be approved as an option - best of luck and post how you get on
I just had my latest Skype consult with Dr Nat Lenzo in Australia.
When my UCLA PSMA scan showed oligo mets in only two pelvic lymph nodes last Fall I asked his opinion: He said there was no data to suggest whether doing SBRT / regional IMRT before vs. after Lu-PSMA treatment was to be preferred. He recommended I do the IMRT to pelvis with SBRT boost first. Two other Rad-Onc consults agreed. That is now recently completed combined with short term ADT.
So now I presumably have no other sites that would "light up" from PSMA remaining. Yet there is a high probability of having some micro-metastatic sites that would lead to recurrence at other sites. So what to do?
Dr. Lenzo agreed with my suspicion that it would be preferable to proceed with one or two cycles of Lu-PSMA now (early 2020) to attempt to treat non-PSMA Pet-scan visible disease. With Lu-PSMA it appears earlier and lower burden disease tends to respond better.
He uses mildly lower dosages (6.0 to 6.5 GBq) and has had some (non-published) early success with similar patients. And with no appreciable increase in side effects.
I plan to try cold packs over the cheeks and ice cubes under the tongue to try to limit salivary gland impact.
The general rule is: you treat with Lu177 what you see on a PSMA PET/CT. If you do not see anything, there is nothing you can treat with Lu177. Dr. Hofman goes a step further, if he sees lesions on an FDG-PET/CT which he does not see on a PSMA PET/CT, he will not treat.
Also I have read that the side effects of Lu177 increase if there is only very little tumor. The ligands do not find tumor to attach to and attach to healthy cells. Dr. Lenzo may avoid that by using a very low dose.
Frankly, I do not think you will have much success with a Lu177 treatment for invisible mets. How will you ever know that it worked at all? What you can do is observe the PSA value. Whether this stays low because of the IMRT/SBRT radiation or the following Lu177 treatment cannot be determined.
Very interesting. Dr. Lenzo is suggesting Lu-177 to treat "possible" micro-mets instead of hormone therapy? Did you discuss Zytiga, Xtandi, or other options?
I am still hormone sensitive so not considering tertiary AR drugs just yet. Yes treating unseen and therefore unconfirmed micro mets is not conventional practice. But I do know my cancer expresses some PSMA. And that SBRT trials shows that essentially all patients have recurrence in non treated
Sites within 2 years. And we know micro meta will not light up on the PET scan until they grow to sufficient cell mass. Further that the 1 mm path length and 0.3 mm penetration of Lu beta particles should be effective in smaller tumor volumes. It is from these considerations that I have decided to proceed. My pre radiation PSA was 0.25 and being HS he advised the chance of a FDG PET being positive would be extremely low at this time. The Lu-PSMA dose will be modestly reduced 6-6.5 GBq instead of 8-8.5.
This is a more pro-active approach to the situation if my post RT PSA nadir is above detectable.
Thanks for the considerations you put forward that are also very valid and why this is a trickier choice.
Sorry you are where you are. Best of wishes.
Eclipse Trial Update - Lutetium-Lu 177 
LU-177
Discussion of Phase 2 trial with LU-177 PSMA-617
Early access to LU 177
German clinics and Lu-177
