Radium223 thoughts?

Radium223 instead of Cabitaxcel, since my mets are in the bone - and doxetaxcel did not prove long lasting results. (PSA is now 116, other stats in "normal" range) Doc thinks radium will produce better results and hopefully take us to LU177 in Q2. Thoughts?

[Tall_Allen]

Great idea! Consider combining with Provenge:

ascopubs.org/doi/abs/10.120...

[V10fanatic in reply to Tall_Allen]

Are there any trials that show how long the Provenge/RA223 pairing stays viable? I completed my Provenge in June of 2020 and have started Xgeva, but my MO suggests I wait to begin RA223 until my Lupron/Zytiga treatments become ineffective.

[Tall_Allen in reply to V10fanatic]

That's because you can't combine Xofigo and Zytiga. But Xofigo and docetaxel seem to work well together:

ejcancer.com/article/S0959-...

[Magnus1964]

Radium 223 would be a good next step. I just finished my 6 infusions and feel good. I haven't had any scans yet. My research doctor thinks it's better to wait a few months.

[GP24]

The treatment will take about five months and your PSA value will continue to rise during that time. Often patients stop the treatment because they see no drop in the PSA value. On the other hand, it is an effective treatment.

I would rather use Lu177, if available. This usually reduces the PSA value after the first infusion already.

[Hidden in reply to GP24]

LU177 isn’t available to me yet, talked to Doc and he told me “not to chase” the trial. He feels Radium-223 will get me to Spring which is when we should see it. . I hope he’s right... Thanks for sharing your experience

[GP24 in reply to Hidden]

You will need six injections for Xofigo to work. You will not see your PSA value drop so it may seem that it does not work.

If you can afford it, you can combine Xofigo with Provenge as Allen suggested.

[EdBar in reply to Hidden]

If by your response you are saying you would do Xofigo now and it’ll get you to the spring when Lu177 is available it was explained to me by Dr. Sartor, who oversees an arm of the Lu trial that it’s either/or when it comes to Xofigo and Lu. It would be too much radiation to have both. Once you get one it precludes the other.

Ed

[monte1111 in reply to EdBar]

I read that before on this site. How unfortunate. Has anyone seen this in writing anywhere? Cause if it's in writing, then it's true. What's a person to do? Flip a coin?

[EdBar in reply to monte1111]

Well coming from Dr. Sartor who is the lead MO on an arm of the LU 177 trial I’d take it to the bank. But consult with your MO to see if that may have changed, if not you have to decide what’s best for your individual situation. It seems like the jury is still out on the long term effectiveness of Lu177, waiting for trial results, which should be out soon.

Ed

[tango65]

Consider Lu 177 PSMA trials. You could qualify. Lu 177 PSMA is a systemic treatment and will treat the cancer anywhere in the body, instead of only in the bones as with Radium 223.

This is a list of the clinical trials in the USA

clinicaltrials.gov/ct2/resu...

[6357axbz in reply to tango65]

Unfortunatly, for many of us, these trials are only for mCRPCa

[tango65 in reply to 6357axbz]

Yes, it is a disgrace they don't have trials for castration sensitive cancer.

Three-tz has a castration resistant cancer and I believe he could qualify.

People with castration sensitive cancer could consider to have Lu 177 PSMA in Europe or India, if financially possible and want to brave international travel during the pandemic.

[GP24 in reply to tango65]

Tango, you and I were treated with Lu177 while being hormone-sensitive. But this is an exception in Germany. My doctor wrote in his report that I am resistant. I guess he wants to be able to say: oops, I thought the patient was resistant.

[tango65 in reply to GP24]

There are other places in Europe and India treating castration sensitive metastatic cancer with Lu 177 PSMA. Paige20180 just had treatment in India.

[Schwah in reply to GP24]

what were the results and SE of your LU177 treatments ?

Schwah

[GP24 in reply to Schwah]

Please read this thread:

healthunlocked.com/advanced...

Currently my PSA value is rising again and my PSMA PET/CTs show no metastases. So I plan a Cholin PET/CT to detect PSMA negative mets.

[Hidden in reply to tango65]

Thanks for the link, read thru the criteria and it looks like I can’t be in the trial if I’ve have radium within 28 days of commencing - Radium on Monday.. someone in this thread mentioned “ coin flipping” , that’s just how we feel sometimes. How can we ever know if we’re making the right choices?

[tango65 in reply to Hidden]

These links how data about Lu 177 PSMA and about Ra 223 results:

nejm.org/doi/pdf/10.1056/NE...

pubmed.ncbi.nlm.nih.gov/317...

[Claud68]

My husband had Lu177 treatments in Vienna/Austria and had no ADT before, only RP. There was the only Doctor, Prof. Markus Hartenbach, in 2019 for Lu177 treatment who accepted people with castration sensitive PCa.

In Netherlands there is currently a clinical trial with Lu177 for non castration resistant Pca .

In several years it will maybe become SOC??

[Walkingwell]

Yeah, good idea, I think. I've had 4 of 6 shots of Xofigo so results aren't clear yet. Docetaxel didn't work for me and I only have mets to bones and was in good shape when I started Xofigo. I've found Xofigo side effects heavy at times, though this isn't the case for everybody. Many other treatments I tolerated well. My PSA went up after first shot but then down twice, maybe because I'm also taking Erleada / Apalutamide.

[RJ-MN]

Three-tz, I haven't had much gain from docetaxel either. I started it in April with a PSA of 36.0, and it had risen to 50.9 after 3 dosings. We added carboplatin in June, and PSA is now 60.9 after 8 dosings of docetaxel and 5 of carboplatin. Mayo oncologists either tell me to save rad223 for pain palliation or they mock it as a waste of time ("Why would anyone waste 6 months doing nothing but watching their PSA rise?!") However, my outside-Mayo oncologists lean towards viewing rad223 as more than pain palliation, and both theorize that the good it might do may be more in a more physically-able patient than in one who saves it for pain palliation near the end of life. I think I am leaning towards their point of view. Mayo only has cabazitaxel as their last protocol/available treatment (other than spot radiation for pain), and I hesitate to use their last step in 2020!

[Hidden in reply to RJ-MN]

Right, we are at Mayo AZ. We are fortunate that it has not traveled further than bones, although Mets are extensive. Our Dr. also saving cabitaxcel for systemic use later. LU177 is anticipated to be available to us in 2021 second quarter. Thanks much for adding your opinion. It can be so overwhelming ,we are all so different, so many factors to consider when deciding on a treatment. Then seems like we’re all crossing our fingers that whatever we’re doing works. Good luck and health to you in your journey.

[pilot52]

If you can get to UCLA and get a PSMA scan, 2900.00 and change plus travel...and traveling to another country is something you would consider along with a positive scan showing PSMA uptake then you may want to jump to Lu-177. A couple of us are currently going to India for Lu-177. Headed back November 13th...we are here to guide you through the visa and paperwork. Ishita Sen heads Nuclear Therapy Dept. She is very accessible . She travels the globe and knows her stuff. If we can help,

message me..Blue Skies ...Sky King and Penny (woof)

[6357axbz in reply to pilot52]

Why India instead of Germany?

[pilot52 in reply to 6357axbz]

I am chemo naive which shows a much better response. Germany as policy will not treat chemo naive. Braun did but he is 85 and mostly retired . That is why he does not answer e-mails. Isreal also will treat chemo naive cases. Michael Hoffman , Australia knows my OC at Duke and wrote a very cordial and information packed letter to me. They only are in clinical trials for chemo naive and he wants only residents of Australia in these do to intense follow up. Lu-177 is produced in Germany and shipped to India and elsewhere so you are getting the same meds. If you are chemo naive they have found they can give you a higher dose since bone marrow is virgin....It is a simple infusion followed by 3 days of followup. First trip you need to arrive a couple of days early for workup...I had really high uptake. The night following I felt like I was shot in the back with bird shot pain was a 6 maybe and perfectly controlled with OTC.I did. two OTC pain relievers 8 hours apart and none since. That is very positive. I had 14 plus bone mets. I am two weeks out and have 0 bone pain....Glad to share more if anyone interested....2016 Gleason 9 12 cores. Blue Skies...

[6357axbz in reply to pilot52]

Very informative pilot. Thanks

[6357axbz in reply to pilot52]

I recently had UCLA scan and am currently completing the zapping of all mets showing on that scan. That being the case it seems I’d be premature for LU177, unless LU177 has been shown to destroy micro metastices. That has not happened has it?

[Fitzbruce1 in reply to pilot52]

Do you know who I would contact in Israel? I am still sensitive and healthy. Thanks, Bruce

[Fitzbruce1 in reply to pilot52]

Pilot52- do you know who I should contact in Israel? I am sensitive and healthy. Thanks, Bruce

[pilot52 in reply to Fitzbruce1]

[e-mail]

[Fitzbruce1 in reply to pilot52]

Thank you!

[pilot52 in reply to Fitzbruce1]

you have a two week quarantine but you can go back and forth to the hospital during that time...

[Fitzbruce1 in reply to pilot52]

Good to know. I have good friends that live there. They have asked us to visit them many times. Maybe this will be the catalyst for the visit.

Thanks again

[Hidden in reply to pilot52]

Thank you!

[6357axbz]

Unlike Xofigo, which only attaches to bone metastases, Lu-177-anti-PSMA attaches to any metastasis — bone, lymph node or visceral. It can potentially treat systemic micrometastases as well. It has the potential ability to kill many more cells because of the increased range of the β-particle.

[pilot52 in reply to 6357axbz]

You are 100% right on that!!

[Pianodude]

My oncologist doesn't want to give it to me until I become castration resistant. I have extensive bone mets that were not reduced much by docetaxel and firmagon. My PSA went from the 600s to 0.6, but my scans were less than spectacular. I don't understand why we should wait. It makes no sense to me other than maybe the system doesn't want to spend the money until they have to.

[Hidden]

We’ve been told we’re resistant, my PSA is doubling every month or so.

[MateoBeach]

You have to weigh the total body radiation burden vs expected benefits. Xofigo is good for bone mets. Lu177 does not work as well for bone as it does for nodes. Yet it works better early rather than in later, more advanced diseases. (See previous forum posts on Lu177 for reference articles). Like you I am HSPC and there is no way to get insurance or Medicare to cover Provenge until mCRPC - even thought the immune mechanism has no known association with hormonal status and probably works better in earlier HSPC. I just tried to get it. Way too expensive to pay out of pocket.

But also Lu-PSMA treatment may be coming into approval within the year. Who knows? If it were me with predominantly bone mets I would probably lean towards Xofigo. Regardless, we are all so in your corner!

[V10fanatic in reply to MateoBeach]

Anthem B/C B/S approved my Provenge even though I was still hormone sensitive. Your MO needs to know how to push a little sometimes.

[MateoBeach in reply to V10fanatic]

Thanks. Then I am going to push for Provenge approval again. Can you tell me if your Anthem BCBS is Medicare supplemental or is yours completely separate from Medicare?

[V10fanatic in reply to MateoBeach]

It is a private policy through the ACA exchange here in Colorado.