Car-t vs regeneron vs Lu177

[Rexwaterbury]

I had a long conversation with Dr Drake today regarding my treatment options for mCRPC after having failed xtandi and zytiga, and after recently finishing chemoRx with progression on my latest scans. His recommended options were Psma Car-T (high risk/high reward), Regeneron trial, or Lu177 at Bad Berka. He said which option I chose was dependent upon my risk tolerance, as there is no data comparing one to the others. Much information to process. My head hurts.

[Tall_Allen]

Remind me again - your PSMA and FDG scans did not show heterogeneity?

[Rexwaterbury in reply to Tall_Allen]

I have a Psma scan at UCLA on Jan 3. No FDG scan as yet.

[Tall_Allen in reply to Rexwaterbury]

You can get FDG the next day - some dietary restrictions - -insurance should cover that one. You can decide among alternatives after you have that data. There's the AMG 160 trial in LA. We're seeing Aggarwal next week about HPN424 . There's also the REGN5678 trial in NYC. All very similar. I have lots of questions - I'm worried that they're all too specific.

[Rexwaterbury in reply to Tall_Allen]

What are the AMG and HPN trials?

[Tall_Allen in reply to Rexwaterbury]

Look at the (1-4) links in the last paragraph. They are all pretty similar: a t-cell recruiting antibody attached to a PSMA ligand with a checkpoint blocker.

pcnrv.blogspot.com/2019/12/...

[Tall_Allen in reply to Rexwaterbury]

You can also decide based on that if Ac-225 PSMA is more appropriate, or a mixture. My preference is Heidelberg because Haberkorn is doing all the innovation, and Bad Berka is such a shlep to get to (although I'm sure it's a beautiful resort if you want a vacation). I have a question- does Bad Berka have its own hot lab where they make Lu-177 fresh, or do they ship it in from a cyclotron elsewhere?

[Rexwaterbury in reply to Tall_Allen]

Thanks for your input. I am not sure where any of these facilities obtain their radioisotopes.

[Tall_Allen in reply to Rexwaterbury]

I guess if it is less potent, they just give more. Even the ligand w/o the radioisotope has some value.

[gyancey in reply to Tall_Allen]

Bad Berka has to have Lu-177 shipped.

[cesanon]

Does Dr Drake prefer Bad Berka for LU-177?

[Rexwaterbury in reply to cesanon]

Yes. Bad Berka is his preference for Lu177 due to their adjustments of dosage based on the appearance of the scans.

[GP24]

I would prefer the Lu177 treatment because it has only very limited side effects, at least the first two cycles.

In Germany there is no FDG PET/CT required to get an Lu177 therapy. It was not required in the VISION trial also. They do look at an FDG PET/CT in Munich when there are liver mets, because these are frequently PSMA negative.

[snoraste]

The target is all these trials is PSMA. I don't know of any studies comparing efficacy/side effects of CAR-T vs Lu177 targeting PSMA. To me, Lu177 appears to be a safer choice, just because there's a lot more collective experience about its application and longer term response.

On the other hand, if your MO has a convincing case for one vs the other, worth giving it a fair hearing.

[Patrick-Turner]

A problem with trials is that patients are randomly assigned to one thing or another, and one here in Australia offered Lu177 or Cabazitaxel, a newer type of chemo, and I'd just failed Docetaxel, so I risked not being assigned to Lu177, so I just bought the Lu177 from Theranostics Australia. Now I realise that although the Lu177 I did get seems to have worked OK with following added Xtandi, there may be a Pca recurrence of Pca that didn't make PsMa and I'd need to consider FDG scan and whatever is used other than Lu177. It's not over yet.

Patrick Turner.

[AlanLawrenson]

My brother had great response from his 4 cycles Lu-177 in Oz. However after last injection in Feb 19 , his PSA in July was less than. From Oct to now gone from 100 to 315 (in 2 weeks) to 440 (10 days later) and two weeks ago 740. I suspect that TA's heterogeneity has caused my brother's PCa to see him hospitalised and in generally a declining position. His too recent PSMA PET and FDG PET scans would prove it, but no one available to review this. He is moving tomorrow to a teaching hospital.

The level of aggressiveness of his PCa has not been satisfactorily explained.

[marnieg46 in reply to AlanLawrenson]

Alan, I'm sorry to hear your brother is not doing so well. Hopefully, he'll fare better in a teaching hospital. Our teaching hospitals, either in Sydney or Melbourne, are as good as anywhere in the world in Australia with some of the very best specialists. Hopefully when you post again there will be some very good news.

[Claud68]

I think that Lu177 works better on patients without bone mets and if they had no chemo before. Otherwise the combo treatment with Actinium225 could be more appropriated.

[GP24]

One of the alternatives you mentioned is "Lu177 at Bad Berka". Prof. Baum, who led the nuclear treatment at Bad Berka, is working at Wiesbaden next year at this clinic:

helios-international.com/en...

He told me that he will be offering Lu177 and Ac225/Lu177 treatments there. No FDG PET/CT required. You can reach Wiesbaden from Frankfurt airport with a cab.

He also got a brand new PSMA PET/CT system there which detects lesions of 2 mm in size. This makes it difficult to be oligometastatic I guess.

[Rexwaterbury in reply to GP24]

Thanks for the info. Dr Drake feels comfortable that all of his associates can provide the same treatment as Dr Baum. But I will inform him of Dr Baum’s new location. Do you know exactly when he begins his work in Wiesbaden?

[GP24 in reply to Rexwaterbury]

He will begin next month. So you can contact him for an appointment in January.

[j-o-h-n]

I agree "my head hurts" too... Keep on keeping on.... and -

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 12/23/2019 6:56 PM EST