Update on my Lu177 in mHSPC setting

[snoraste]

I just wanted to give a quick update.

I stopped the SOC treatment in March19, with the idea of hitting it when it comes back with LU177. I started the first infusion LU177 in Oct, followed in 6weeks by one in Nov and the latest now In Jan2020 after 8week.

PSA gradually dropped all the way thru December, and a PET/CT done in the middle of Dec showed status quo. I've been taking Finasteride (and statin+metformin), and I stopped taking them 10days before treatment. My next PSA done 3 weeks later was double. I was shocked, but both my MO and I thought it maybe perhaps due to discontinuation of Finasteride, given PET/CT was unremarkable.

I did a PSMA scan yesterday, and it definitely shows progression, following the two LU177 infusion. Lots of new small bone mets in upper body now. I'm shocked at how quickly it turned around and how many of them. I did the 3rd infusion, per MOs here, but LU177 seems like a bad failure for me, and I was quite sad about it because I hoped it could buy me some time. O well.

Back to the drawing board.

[tallguy2]

Sorry to hear your report. Thanks for sharing it with the group. Best wishes as you seek that next treatment.

[Tall_Allen]

I'm so sorry it didn't work for you as you expected. Repopulation by non-PSMA-avid cancer cells can make the cancer cells grow more quickly after treatment

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

[snoraste in reply to Tall_Allen]

Thanks Allen - The mets show up with PSMA scan. So they are still PSMA expressing (perhaps not avid). Also I thought my BRCA+ would help the cause. I'll be doing an uptake scan tomorrow and will know more.

[Tall_Allen in reply to snoraste]

There is a trial in Melbourne of whether a PARP inhibitor might radiosensitize to PSMA therapy. It seems ideal for guys who are BRCA+

clinicaltrials.gov/ct2/show...

[PhilipSZacarias in reply to Tall_Allen]

A very good point. This clearly shows again that metastases are composed of mixed populations of cancer cells. Killing off the PSMA expressing cells released the non PSMA cells from competition. This further indicates that adjuvants should be used. Regards, Phil

[tango65]

Sorry to hear the Lu 177 PSMA treatment is not working well. Perhaps you should consider to start enzalutamide for at least 10 days before doing the next treatment. Ten days of enza could increase the expression of PSMA and it could make the treatment more effective:

healthunlocked.com/advanced...

sci-hub.tw/https://link.spr...

Best of luck!!

[Rexwaterbury]

I’m sorry to hear this. Do you suppose that since you are not mCRPC, that perhaps your lesions we’re not intensely Psma avid enough for a successful outcome?

[ToniTbird]

My hubby has first treatment of Lu177/AC225 in Germany and PSA went from 790 to 460 in 3 weeks. Starting week 4 it went up and up and up to now over 1000! No more treatments and his liver is blown up with tumors. Very disappointing when hoping it was going to really help!

[GP24 in reply to ToniTbird]

I am very sorry to hear that. Lu177 does not work well for liver mets.

[GP24]

After three cycles of Lu177 I would consider possible side effects of this treatment if you continue.

There is currently a trial with immunotherapy offered by many clinics called KEYLYNK-010. This combines Pembrolizumab with Olaparib. So this could work for you.

clinicaltrials.gov/ct2/show...

There is a drop-down list on this page with 162 study locations.

[GP24 in reply to GP24]

I forgot, this trial is just for CRPC patients. If you do not have more than 10 mets, you can take part in this trial with SBRT radiation:

bmccancer.biomedcentral.com...

[Jackpine]

Snoraste,

Sorry to hear the failure of LU177. Like you I was very hopeful that it would beat this back and give some relief for a year or two. I did six injections last year PSA went from 110 to 0.4. Within 4 months of completing treatment PSA is back to 15 and multiple bone Mets.

Back doing chemo now.

Stay strong this cancer is a tough beast, We have not found the silver bullet yet but I’m still hopeful.

[jfoesq]

Keep fighting!

[snoraste]

Thank you all for your support. I spoke to Dr. Weber here at TUM and my status is not entirely clear. I will need to monitor my PSA and see if it drops or go up, and if drops again, doing another treatment here in Germany. Anyhow, he did mention (and I found it very important) that based on his experience here, he finds patients not responding to Lu177, typically respond better to AC225. He also mentioned they will be offering a new target for radionuclides (I believe it was FIPA, but he mentioned another technical name for it which escapes me now), as early as a year from now. I will keep you posted as I get more relevant info.

[Rock45]

Really appreciate your post on Lu-177 in the mHSPC setting. I am hormone sensitive and came off of ADT in January 2019 for same reason. Had the PSMA PET on 11/1/19 and then a FDG PET to confirm good candidate after reading Tall Allen's 12/15/19 blog post in late December. Will see what's recommended but definitely concerned about repopulation and making matters worse since haven't exhausted Zytiga or tried enzalutamide. Wish you the best and keep up the fight!

[snoraste in reply to Rock45]

I just want to be clear that my issue is not repopulation. We don’t know what it is. I’m still very much PSMA avid. There are a few members here who have had a good response with LU177. So definitely worth discussing with your MO. I think you have a window of opportunity here in your mHSPC setting and have to figure out how best to utilize it.