Lu 177 vs chemo/docetaxel.
What are the requirements to be able to be on Lu 177 in the U.S? Are they different in Germany? In Australia? Has anyone seen any studies--from the U.S. or other countries--comparing the effectiveness of Lu 177 to chemo/docetaxel? I am on Lupron, which I understand at some point won't continue to hold down my PSA. Then I'll have to exercise other options--such as Lu 177 or chemo.
Hello,
Normal procedure is to go to on one of the second tier drugs like Xtandi (enzalutamide) or Zytiga (abiraterone acetate) and then move onto Lutetium 177 or chemo when those drugs fail. Some of the German clinics like you to be on Xtandi prior to going on Lutetium. It increases the effectiveness of the Lutetium. Hope that helps!
We found a radio oncologist in Vienna, Austria who accepted to administer the Lu177 treatment instead of any ADT or RT after the biochemical recurrence following the RP. The Ga68-PSMA petscan detected 6 mets in lymphnods. After three Lu177 shots the PSA dropped from 4.4 to 0.34 and maybe it will continue to fall. We'll check in March or April if all the mets disappeared and if there are no news ones.
The most ROs in Germany accept only castration resistant patients after ADT.
Thanks everyone for your responses to date.
Can you give me the name of the radio oncologist in Vienna? I am looking for such a person here in Vienna.
My husband was treated in Vienna/ Austria by Prof. Markus Hartenbach even he was totally hormone naive.
On the website minute-medical.com you will see a lot of information. He speeks also English very well and his phone number is +43 677 625 45515.
We paid 14000€ for each treatment and before, my husband had a Ga68-PSMA petscan in Vienna too, it was 2250€. I know that the main hospital in Vienna, AKH, treats some patients after ADT and/ or Chemotherapy with Lu177. I think that it is free if you are resident in Austria?
The open US trials in SF and NY require chemo before Lu-177-PSMA. There are no comparative effectiveness studies.
Tall_Allen, do you know what the situation is outside of the US in terms of prerequisites for Lu-177?
In Germany, India and South Africa, you can get Lu-177-PSMA outside of clinical trials.
Thanks.
You can also get it from Australia outside a trial.
I read Lu177 is more effective before chemo. mdpi.com/1424-8247/15/10/12...
Many misunderstood that, but there is really no such evidence yet.
As you can in Australia. About US$7000 per treatment. My brother had 4 cycles and to an extent took his eye of the ball at a critical time. His PSA went from 1 to 105 in 8 weeks, more than doubled again in two further weeks and then doubled again. Sadly, he died 4 weeks ago. When he started having pelvic pain, he should have started docetaxel immediately. He might still be alive today, if he had done so.
However, it is possible that, in hindsight, his Stage 4 cancer morphed in neuroendocrine PC, which is extreme aggressive form of CRPC. The docetaxel would then not have helped him.
Go to theranostics.com.au for more details.
Are you currently only doing Lupron? I believe more the standard now, depending on diagnosis details, is ADT plus either Zytiga or Chemo. As per current studies. Not waiting for lupron to stop working before adding chemo or Zytiga. Not sure if LU 77 has the same studies.
UW Madison is currently doing a Clinical trial UW 18028 It is a phase I/ll dose escalation study of safety tolerability, pharmacokinetics, dosimetry, and response to repeat dosing of 177LU-PSMA radio-ligand therapy in patients with prostate specific membrane antigen PSMA positive (68Ga-PSMA-R2) progressive metastatic castration resistant prostate cancer. It is open and there are two phases. The first phase requires weekly blood work at UW. The second phase requires blood work every 2 weeks at UW. Treatment are every 6 weeks. My husband had his first infusion yesterday and he has to follow some strict restrictions for 3 to 7 days due to radioactivity.
You can find this study by using Google put in UW clinical trials prostate and look for the number.
Read my posts regarding radio ligand. Three treatments in Bangkok and I'm in remission with no Mets.
The study at UW requires previous systematic treatment. UW18028. Where this treatment will fit in the treatment sequence is not yet known. I thought I read a study that suggested better results if the person did not have chemo first. This treatment in the US is still available only in clinical trials
At the moment, Lu-177 is only available through a limited number of clinical trials in only one location in the U.S...It is available in Germany if you can afford it..At the moment, it's a last resort treatment and it does not provide a cure, If you are lucky, it can extend mortality significantly..This is serious radiation treatment and it can have serious side-effects..
Thanks for the helpful additional responses.
Can you give us more info about yourself? age, location, treatment center(s),doctor's name(s). All info is voluntary but it helps us help you and helps us too. Thank you!!!
Good Luck, Good Health and Good Humor.
j-o-h-n Thursday 02/20/2020 6:25 PM EST
Read my previous posts re: radioligand.
Thank you for your response which referred to your bio in your home page. Best wishes to you and your wife....
Good Luck, Good Health and Good Humor.
j-o-h-n Saturday 10/24/2020 12:36 PM DST
If you missed this post, you may be interested in this post by "pjoshea13
" 3 months ago.
PSMA expression & Survival in advanced PCa treated by 177 Lu-PSMA-617 Radioligand Therapy
pjoshea13•
3 months ago•5 Replies
Interesting new German study below [1].
***
The terms used below are:
PSMAaverage ... lowPSMAaverage ... highPSMAaverage
PSAmin ... lowPSMAmin ... highPSMAmin
PSMAmax
***
"PSMAaverage was a significant prognosticator of overall survival in contrast to PSMAmax (HR: 0.959 ... vs. HR: 0.992 ...).
"Patients with low average PSMA expression (lowPSMAaverage) had significantly shorter survival compared to those with high average expression (highPSMAaverage) (5.3 vs. 15.1 months ... HR: 3.738 ...).
"Patients with low PSMA expressing metastases (lowPSMAmin) had shorter survival compared to those without a low PSMA expressing metastasis (highPSMAmin) ... 7.9 months vs. 21.3; HR: 4.303, ...).
"Patients that were classified as highPSMAaverage but with lowPSMAmin had an intermediate overall survival (11.4 months; longer compared to lowPSMAaverage, 5.3 months ... but shorter compared to highPSMAmin, 21.3 months ...)."
-Patrick
[For more detail, send me a private message.]
[1] pubmed.ncbi.nlm.nih.gov/326...
Theranostics
. 2020 Jun 19;10(17):7812-7820. doi: 10.7150/thno.47251. eCollection 2020.
Analysis of PSMA expression and outcome in patients with advanced Prostate Cancer receiving 177 Lu-PSMA-617 Radioligand Therapy
Robert Seifert 1 2 3 4 , Konstantin Seitzer 1 4 5 , Ken Herrmann 2 3 4 , Katharina Kessel 1 , Michael Schäfers 1 4 , Jens Kleesiek 3 6 , Matthias Weckesser 1 4 , Martin Boegemann 4 5 , Kambiz Rahbar 1 4
Affiliations collapse
Affiliations
1 Department of Nuclear Medicine, University Hospital Münster, Münster, Germany.
2 Department of Nuclear Medicine, University Hospital Essen, Essen, Germany.
3 German Cancer Consortium (DKTK).
4 West German Cancer Center.
5 Department of Urology, University Hospital Münster, Münster, Germany.
6 Division of Radiology, German Cancer Research Center, Heidelberg, Germany.
PMID: 32685021 PMCID: PMC7359095 DOI: 10.7150/thno.47251
Abstract
Rationale: PSMA-PET-CT enables measuring molecular expression of prostate-specific membrane antigen (PSMA) in vivo, which is the target molecule of 177Lu-PSMA-617 (Lu-PSMA) therapy. However, the correlation of PSMA expression and overall survival (OS) in patients treated with Lu-PSMA therapy is currently unclear; especially with regard to coexistence of high and low PSMA expressing metastases. To this end, this retrospective single arm study elucidates the correlation of PSMA expression and overall survival in patients treated with Lu-PSMA therapy. Additionally, PET based criteria to define low PSMA expression were explored. Methods: Eighty-five patients referred to Lu-PSMA therapy were included in the analysis. Pretherapeutic 68Ga-PSMA-PET-CT scans were available for all patients. SUVmax of the highest PSMA expressing metastasis (PSMAmax), SUVmax of the lowest PSMA expressing metastasis (PSMAmin), and average SUVmax of all metastases (PSMAaverage) amongst other PET parameters were measured for each patient. A log-rank cutoff-finder was used to determine low (lowPSMAaverage) and high (highPSMAaverage) average PSMA expression as well as low (lowPSMAmin) and high (highPSMAmin) minimal PSMA expression. Results: PSMAaverage was a significant prognosticator of overall survival in contrast to PSMAmax (HR: 0.959; p = 0.047 vs. HR: 0.992; p = 0.231). Optimal log rank cut-offs were: PSMAaverage = 14.3; PSMAmin = 10.2. Patients with low average PSMA expression (lowPSMAaverage) had significantly shorter survival compared to those with high average expression (highPSMAaverage) (5.3 vs. 15.1 months; p < 0.001; HR: 3.738, 95%CI = 1.953-7.154; p < 0.001). Patients with low PSMA expressing metastases (lowPSMAmin) had shorter survival compared to those without a low PSMA expressing metastasis (highPSMAmin) (p = 0.003; 7.9 months vs. 21.3; HR: 4.303, 95%CI = 1.521-12.178; p = 0.006). Patients that were classified as highPSMAaverage but with lowPSMAmin had an intermediate overall survival (11.4 months; longer compared to lowPSMAaverage, 5.3 months, p = 0.002; but shorter compared to highPSMAmin, 21.3 months, p = 0.02). Conclusion: Low average PSMA expression is a negative prognosticator of overall survival. Absence of low PSMA expressing metastases is associated with best overall survival and the maximum PSMA expression seems not suited to prognosticate overall survival. Low PSMA expression might therefore be a negative prognosticator for the outcome of patients treated with Lu-PSMA therapy. Future studies are warranted to elucidate the degree of low PSMA expression tolerable for Lu-PSMA therapy.
Keywords: PSMA PET; PSMA radioligand therapy; prognosticator; prostate cancer.
© The author(s).
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Good Luck, Good Health and Good Humor.
j-o-h-n Saturday 10/24/2020 1:31 PM DST
That's all Greek to me John. I went in cold turkey no previous meddling around. My Thai Oncologist said he was interested in my case as I was unusual in that most of the radio ligand patients were end stage. My aerobic fitness and the fact that I had just returned from a cycling trip in Vietnam where we covered from 80-110 km per day for 10 days made him interested in my case.
We are leaving for Delhi, India tomorrow and being treated by Dr. Shen at Fortis Memorial Research Institute. Cost is $5,500 US. My husband is still hormone sensitive. He was on Lupron for 14 months just prior and 1 year after radiation to his pelvis.
Great that you found a place to go with a good reputation that you can get to. Safe travels and hope all goes well with the treatment!🙏
Keep us posted.
India has over 200,000 Covid cases per day. Take all precautions.
Read my posts. I think it will be informative for you.
It was 998. It seems there are different interpretations. It was really high and my initial PETScan showed I was lit up like a Christmas 🎄. Nothing showing now. I met someone who had their treatments in Germany and the protocol was much different. They had to stay in hospital for 2 days post treatments and no more than one treatment every two months. In Bangkok I was in and out in a little over three hours and one month between treatments.
Hi Runner4000.
We are currently in New Delhi for round two of LU177. We are seeing Dr. Sen at Fortis Memorial. My husband has never had chemo and he is hormone sensitive.
He was taken off Lupron for a year and developed metastasis. His doctors wanted to see if radiation to the prostate bed had worked. Charlie was on Lupron for 1 year after his prostate bed was radiated in 5/18. Lupron wore off 6/19. The lesions that resulted from ending Lupron were treated with Radiation. His hip metastasis was eliminated but metastasis on his spine did not respond long term to radiation.
Our doctor recommended LU177. PSA went from 4 to .24 six weeks after first treatment. Casodex was started 1 week before the .24. We can not be entirely sure if the reduction was from LU177 or Casodex. PSA one month after LU177 was about the same. We had a long delay trying to get an Eligard shot so Casodex was used a week prior to the .24 PSA.
The PSMA done yesterday shows a 76% reduction in 4 lesions after 8 weeks. To be clear, the treatments that could have caused this reduction are Lutecium given 8 weeks ago, Casodex taken for 12 days week 4-6. Eligard injection week 5.
I was in the room for Charlie's second treatment and slept next to him as normal 6 hours after treatment. Much different than I hear they do things in Germany.
I feel like Charlie is a bit of an experiment doing Lutecium early in his treatment and the results will play out. All the best to you!
Lu 177 along with AC 225
Lu-177 and cremation
Lu 177 PSMA 
