Cholera vaccine before LU177?

[snoraste]

I'm doing my 3rd LU177 infusion in 2 weeks at TUM. I'm also scheduled to receive my Cholera vaccine next week (Vaxchora). Thinking about postponing the vaccine till a couple of weeks after LU177. I read somewhere there maybe a potential drug interaction. Any thoughts?

[LearnAll]

Whatta Co-incidence. I am drinking Vaxchora cholera vaccine right now as I write this message.

It tastes like sprite soda. I have to wait an hour before I can have my dinner. I dont know about LU177 interaction but it says that antibiotics can not be taken with it.

[snoraste in reply to LearnAll]

😀

Good luck with it - hopefully it works for you

[Danielgreer in reply to LearnAll]

Hi LearnAll, Did your MO recommend the Vaxchora? I’m wondering why my MO didn’t mention it.

[LearnAll in reply to Danielgreer]

My MO did not recommend it. I decided to take it after reading Swedish study. My primary doctor wrote the prescription when i explained about possible benefit.

[Hidden in reply to LearnAll]

LearnAll

Where did you get the liquid vaccine?

Thanks

[LearnAll in reply to Hidden]

At PUBLIX pharmacy in FL

[Kevinski65 in reply to LearnAll]

You're taking the vaccine at home? Where did u get it?

[LearnAll in reply to Kevinski65]

from publix pharmacy..i took it sitting in my kitchen.

[Manilo in reply to LearnAll]

Maybe cholera vaccine increases the infiltrating linphocites and macrophages count. Thus enhancing any possible abscopal effect that radiation from Lu177 could activate.

[LearnAll in reply to Manilo]

The hypothesis is that cholera vaccine stimulates cell mediated immunity via lymphocytes , macrophages and Natural Killer Cells.

[LearnAll]

Yea..15 minutes ago, i was in pharmacy and they handed me this pack of Vaxchora which was ice cold.

[snoraste]

Sounds reasonable Nal - if I take it in Feb, it’ll be 28th month after Dx. I know the study median was about 27.5 months. Close enough.

[LearnAll]

I already mixed contents of both packets in 100 ml of water and drank it 10 minutes ago.

I had DeXa bone density scan this afternoon . My hip T Score increased from -1,2 to -1-6 in last 7 months. I would like to know what can I do naturally besided calcium,Vit D, K2 and execise to T score from falling further.

[LearnAll]

But I took it 7 /1/2 months after diagnosis. Is that wrong?

[LearnAll]

thank you .

[GP24 in reply to LearnAll]

I would get a second opinion on the Gleason score from Epstein. A Gleason of 3+4 and a PSA value of 830 with bone mets is very uncommon. You can still have your paraffin blocks from your biopsy send to them.

pathology.jhu.edu/departmen...

If you do not want to take Xgeva, I would also avoid that, you can take Forteo

forteo.com/taking-forteo

or Toremifene

ncbi.nlm.nih.gov/pubmed/207...

to increase the bone mass or stop loosing any more. You loose most of the bone mass in the first year of ADT but it continues to decrease in the following years.

[LearnAll in reply to GP24]

Thanks GP24, In fact, my PSA shot up vertically like rocket in 2 weeks before diagnosis. I had severe inflammation ,UTI and prostatitis . My Uro says most of the abrupt PSA rise was due to this level of inflammation and not from cancer. The way PSA fell sharly after antibiotics and casodex was also indicative of severe inflammation causing increase in PSA.

[GP24 in reply to LearnAll]

Sending the stuff to Epstein does not hurt. In my case the second reviewer made a 4+4 from the inital 3+4 and I do not have bone mets.

[LearnAll in reply to GP24]

will it change treatment if Gleason comes different ?

I was almost syptomfree even a week before diagnosis and was playing soccer in Sarasota. Even on diagnosis Day, I had no bone pain but bone scan was shining at many places.

[GP24 in reply to LearnAll]

It will not change your treatment currently. But the guidelines group patients into different risk groups and recommend different treatments for these groups. With a 3+4 you would be in "favorable intermediate" risk while 4+4 is high risk. On the other hand with bone mets you are high risk anyway. However, the gleason score is important for your diagnosis and should be correct.

Some patients have no symptoms while the bone scan shines like a christmas tree. They say, doctor you are kidding, I feel great.

[LearnAll in reply to GP24]

Thanks. I might consider rechecking Gleason grade by a different pathologist.

[LearnAll]

Thank you. Can I repeat Vaxchora after 2 years?

[LearnAll]

Soon I will be able to get Niclosamide. Do you think it is still a good idea to add niclosamide if one is harmone sensitive and doing very well.

[LearnAll]

ok. thanks for the explanation. i will keep it for later use.

[Tall_Allen]

Why would you take any drug of unknown efficacy where there is any potential for interference? The list includes all supplements. You're paying a lot for the Lu-177-PSMA treatment. There are some things that may increase the cell-kill rates (like PARP inhibitors), but that has to be explored in clinical trials.

[snoraste in reply to Tall_Allen]

I asked my MOs the same question (both here and at TUM). As you and others have said, very little scientific evidence and that's why I posted here for opinions. My inclination was same as yours, to wait. I'll see what the TUM people say, and perhaps I wait a few half-life cycles.

[TeleGuy in reply to snoraste]

I second the motion. I’m off to TUM for round #2 in a few weeks and I’m following their instructions to the letter. Too many unknowns mixing stuff up. I was reluctant about stopping abiraterone for this but understand that the interactions are unknown.

[MateoBeach in reply to Tall_Allen]

And the big one emerging is Vayonda (NOX66). DARRT-1 results are startling. Now being explored with Lu-PSMA in the manufacturer sponsored (Noxpharm) LuPIN trial.

globenewswire.com/news-rele...

[snoraste in reply to MateoBeach]

Interesting combination. Looking forward to seeing full results. That and PSMA-FAPI trials.

[MateoBeach]

The cholera vaccines (dukoral and vaxchora) are not antibiotics. They are antigens to stimulate specific immune responses. Immune enhancement is generally good for us. There is no obvious reason why they would interfere with Lu-PSMA treatment. In the absence of any specific research, I would not be concerned based on these grounds.

And if the treatment releases antigens from cell contents killed by the Lu-PSMA, then that could generate an abscopal effect, an immune response that can target other PC cancer cells in the body on top of the direct Lu-PSMA effects.

So if the cholera vaccine actually does fight prostate cancer, which is not yet known, then it would be a positive.

More likely, in my view, is that the Swedish study showed that for some reason "the kind of person" with prostate cancer who would choose to have cholera vaccine (dukoral), is more likely to be the kind of person who will survive significantly longer.

So be that "kind of person" and go for it. There is no downside to that!

[MateoBeach]

I understand that niclosamide is specifically for overcoming androgen receptor splice variants, especially ARV7. This emerges commonly in advanced CRPC and especially resistance to advanced AR receptor drugs such as enzalutamide and abiraterone. So no, not for HSPC.

Curious about the failed California Trial.

ncbi.nlm.nih.gov/pubmed/247...

Niclosamide inhibits androgen receptor variants expression and

overcomes enzalutamide resistance in castration resistant prostate

cancer

"In the present study, we screened the Prestwick Chemical Library and identified niclosamide, a FDA approved

drug effective against human tapeworms, as a potent AR-V7 inhibitor in prostate cancer

cells. We found that niclosamide reduces AR-V7 recruitment to the PSA promoter and significantly

inhibits AR-V7 protein expression by protein degradation via the proteasome dependent pathway.

Niclosamide inhibits prostate cancer cell growth in vitro and tumor growth in vivo. Furthermore,

niclosamide overcomes enzalutamide resistance and significantly enhances enzalutamide therapy in

prostate cancer cells, suggesting that niclosamide can be used to treat, either alone or in combination

with current antiandrogen therapies, advanced prostate cancer patients, especially those resistant to

enzalutamide."

[MateoBeach]

Thank you Nals. Curious about nitazoxanide now.

[MateoBeach]

Yes, thank you. Studying now. Very interesting drug. Found a good article explicating mechanisms for enhancing chemotherapy with NTZ in Ovarian cancer model.

ncbi.nlm.nih.gov/pmc/articl...

Another on glioblastoma. Haven't found the Norwegian study yet.