Supplements after Lu 177 treatment

[Vsahay]

What supplements can be given after Lu psma treatment such that it does interfere with the treatment?

Can neem supplement be given?

[LearnAll]

Lueticium177 works by attaching to cancer cells and imploding them. Lu177 doesnot affect the metabolic activity in any other manner.

I see no reason why Neem leaves can not be chewed while on Lu177.

[Vsahay in reply to LearnAll]

Whaat if neem interacts with lutetium and treats it as a toxin?😨😨

[Tall_Allen]

Since you nor anyone else has any idea what the interactions are with any supplements, you should avoid them all during treatment. Why would you compromise your treatment?

[Vsahay in reply to Tall_Allen]

That's the reason for abstaining from use of supplements for long.😂😂

[AlanMeyer]

I see you've gotten advice from one serious optimist and one serious skeptic. Now it's time for a serious kibitzer who knows nothing about it to weigh in.

I did a search of Pubmed for nimbolide and prostate cancer and found five articles. That's not a large number and several of them were from the same folks in Asia, though one was from the Mayo Clinic here in the USA. They all seem to indicate that the active ingredients in neem work by inhibiting a pathway in tumor cells that enables them to live and to proliferate. It also apparently promotes the production of reactive oxygen species, leading to increased oxidative stress in the cells. I didn't see any indication of it providing a protective effect for the tumor cells, for example by suppressing reactive oxygen species (something that "antioxidants" like vitamin C can do.)

So it looks to this non-expert kibitzer like neem is more likely to increase the effectiveness of the Lu-177 by increasing the rate of tumor cell death than to decrease it.

I have enormous respect for Tall_Allen's expertise in all scientific aspects of prostate cancer. He knows much more than I do. However, in this particular case, I think that if I were you I'd be inclined to continue taking the neem. Granted, it's a roll of the dice. Granted, there is no research to indicate that neem and Lu-177 can work together. Granted, the research is probably all in test tubes or in mice. Still, the odds of it helping look a little greater than the odds of it hurting - to me anyway.

Best of luck.

Alan

[Vsahay in reply to AlanMeyer]

Thanks for the valuable opinion😊

[Tall_Allen in reply to AlanMeyer]

Alan, I don't usually read what others write - except for you, because usually your advice is measured and well thought through. I've gotta say your response here surprised me.

Anything taken with radiation has to be radiosensitizing to the cancer (which Neem may or may not be in clinical use - who knows?) But it also has to be radioprotective of healthy tissue. If not, it can cause excess toxicity. With any kind of radiation, as you state above, cell death occurs because of the formation of ROS which Neem may encourage. It also (at least in lab studies) seems to interfere with cell repair pathways. Even without radiation, Neem is toxic to healthy tissue (see links below). So there is every reason to believe that if it increases radiation toxicity to cancer cells, it will also increase radiation toxicity of healthy cells. We are concerned with Lu-177-PSMA with kidney toxicity, myelosuppression and salivary gland damage. We know it is relatively non-toxic to healthy tissue when taken without supplements. Remember that a man who has late-stage prostate cancer is liable to have kidney damage and myelosuppression just from his cancer. Can you guarantee that by encouraging this man to take this stuff with radiation, you are not causing him harm? I guess I have more humility about the vast amount of stuff I know nothing about.

pubmed.ncbi.nlm.nih.gov/249...

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

ajnr.org/content/31/7/E60

journals.lww.com/dermatitis...

BTW- The Peter Mac center in Melbourne is testing several adjuvant treatments that may increase effectiveness of Lu-177-PSMA or they may increase toxicity. (This is why overall survival is the endpointof such trials). But they are doing it the right way - with carefully watched clinical trials.

[AlanMeyer in reply to Tall_Allen]

Thanks for the reply Allen.

I did not know of the dangers since my Pubmed search only looked at neem in the context of prostate cancer. The articles you found do indicate a danger though and, in light of them and in light of your argument, I see that the risks are greater than I realized. An agent that increases ROS can strengthen the effects of radiation on tumor cells but put healthy cells in the path of radiation at greater risk, and in this case the articles you cited show there is a possible danger in neem even without radiation. We just don't know what the outcome will be. My failure to envision the possible negative consequences renders my advice very questionable.

I will still argue however that the risks may, in some cases, be worth taking. Lu-177 is most often given to patients that have failed most or all of the standard treatments. Some of those patients get a complete response. Most don't. If you are in the group of men who are running out of treatments and who are not getting a great response to Lu-177, and who are expecting to die of PCa in not too many months, you might want to roll the dice and try a treatment (neem in this case) that might possibly make your response to Lu-177 greater. It could backfire. It could do nothing at all. But maybe it could extend your life.

In any case, I consider your criticism of my posting to be valid. I will keep it in mind in the future.

Thanks.

Alan

[Tall_Allen in reply to AlanMeyer]

For a discussion of the biggest known reason for Lu-177-PSMA failure, see:

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

Lu-177-PSMA is still very new and we have a lot to learn about adjuvant therapies, optimal sequencing, and patient selection. Clinical trials are ongoing on immune augmentation, adjuvant PARP inhibition, novel ligands, different emitters, and new clinical trials have been proposed. It's a very active area of investigation. Idronoxil (NOX-66) has been proposed as a tumor-specific radiosensitizer for use with Lu-177-PSMA:

ascopost.com/News/60219

I don't really buy into the "what have I got to lose" argument. My reply would be quite a lot. Radioligand therapy, as currently used, is a last chance. As you can read in the link above using historical controls, Lu-177-PSMA treatment probably adds about 3-4 months to expected survival, which is in line with other treatments (Xofigo or Jevtana) in heavily pretreated patients. I would argue that those extra 3-4 months spent with family and friends become more precious than ever. Taking a substance that may interfere with survival at that point may deprive someone of those precious extra months. Also, toxicity effects of any substance are worse in patients whose systems are already debilitated by cancer. I'd argue that if someone believes he must take a supplement, the time to do it is early in progression when toxicity and effectiveness are likely to be better.

As you rightly said, all antioxidants are to be avoided scrupulously. I wanted to take this opportunity to point out another class of supplements that should be avoided with Lu-177-PSMA treatment and Ga-68-PSMA PET scans. It's helpful to understand that these molecules are "chelates." That means the metal (lutetium or gallium) is loosely attached (via the "DOTA" end of the ligand) to the peptide that is attracted to the PSMA antigen on the cancer cell surface. This loose attachment is precarious and can be easily disrupted. Other metals may replace the Lu or Ga. Also, other chelating agents can displace the DOTA chelation. If you look closely at the label of any multi-mineral supplement, it is probably full of chelated minerals. I've seen supplements that contain the powerful chelating agent EDTA. Curcumin, in particular, is capable of forming stable metal ion complexes and should be scrupulously avoided by patients taking Ga-68-PSMA-11, Lu-177-PSMA-617, technetium bone scan, or gadolinium MRI contrast agent. Curcumin is known to confound tests of molecules like PSA and PSMA that penetrate the cell wall. Other substances found in common supplements may interfere as well. Lu-177-PSMA has never been tested with any of these supplements - is it worth the risk?

[Claud68 in reply to Tall_Allen]

And what do you think about modified citrus pectin?

[depotdoug]

I had no idea what NEEM was or does or does not do. Is it not well known?

[Vsahay in reply to depotdoug]

Google nimbolide for more info

[LearnAll]

All I have to say is that I have been taking fresh Neem Leaves for almost 9 months. Recently restarted again as new leaves came on my Neem tree. I have been on Lupron, Casodex. Stopped Zytiga due to High BP.

Just this morning my test result came....PSA 0.3 from 830 10 months ago. Symptom free.

Still walking 5 miles a day and dancing on bollywood songs.

[lewicki in reply to LearnAll]

Where do you buy the NEEM seeds and is there a method to fertilizer the plant. Thanks

[Leader4077 in reply to LearnAll]

How are you doing now with your treatments? Read your results of 2 years ago.Mike

[whwalker1]

What is neem?