Maybe I'm getting ahead of myself, but I think this will become increasingly important. Interesting caution about Chinese food.
Avoiding radiation damage to salivary... - Advanced Prostate...
Avoiding radiation damage to salivary glands with Ac-225-PSMA-617 therapy
Written by
Tall_Allen
To view profiles and participate in discussions please or .
29 Replies
•
Dear Tall_Allen:
1. Wow, what a well-researched article! Thank you.
2. I recollect a while back you mentioned that there was a ligand in early trials that would spare the salivary glands and/or the Kidneys. Did that ligand never pan out?
3. I think dry mouth is a very serious side effect. It sounds non-threatening but I imagine it could be every bit as life-limiting as prostate cancer. Once your teeth and gums go, a lot of things follow.
You read fast! The antibody-based ligands are in clinical trials. It can be serious, and is a reason cited for discontinuing Ac-225-PSMA-617 therapy.
Will the new ligands under trial make it possible that Lu177, Ac225 can be targeted to Pca that does not make PsMa ?
I have a friend who had a small unknown type of cancer in his neck, maybe 12 years ago, and he had surgery, then chemo and EBRT, and that gave him remission from that cancer. A few years later he got Pca, and an RP fixed that, although he needed EBRT about 6 years later, but at 81 he seems OK. But he's had a dry mouth for 12 years and uses some special chewing gum to keep his mouth OK, and he's got teeth and gums.
My dear old mate has had both knees replaced, and is enjoying his walks on the beach.
But we all need a better ligand to target Lu177 and Ac225 to Pca mets, and hope targeting of chemo could also be done to make the chemo dose much smaller and get a much bigger % dose of chemo to invade mets. This would reduce the nasty side effects of chemo on bone marrow immune cells, kidneys, liver et all.
There probably are researches looking for answers we want, but the body and the cancers it gets as we get older are extremely complex.
Patrick Turner.
It's discussed.
But it isn't available therapy yet.
The doc who is willing to give me Ra223 sent info to read :-
Radium-223 mechanism of action: implications for use in treatment combinations
Michael J. Morris1,*, Eva Corey2, Theresa A. Guise3, James L. Gulley4, William Kevin Kelly5, David I. Quinn6,7, Arne Scholz8, George Sgouros9
1Memorial Sloan Kettering Cancer Center and Weill Cornell Medicine, New York, NY, USA.
2Department of Urology, University of Washington, School of Medicine, Seattle, WA, USA.
3Indiana University, School of Medicine, Indianapolis, IN, USA.
4Genitourinary Malignancies Branch, National Cancer Institute, NIH, Bethesda, MD, USA.
5Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
6Norris Comprehensive Cancer Center, Los Angeles, CA, USA.
7Keck School of Medicine of University of Southern California, Los Angeles, CA, USA.
8Bayer AG, Drug Discovery, Pharmaceuticals, Berlin, Germany.
9Johns Hopkins University, School of Medicine, Baltimore, MD, USA.
I don't know if this is online or not, but its a complicated explanation of Ra22 use which I could never fully understand, and I doubt there is anyone where I live in Canberra who could handle Ra223, or know enough to say its OK or not OK for me in my present situation and somewhat excellent health condition.
My onco sent a reply to me to choose which I wanted soon, Ra223 or chemo, without any other comment, and I really doubt he knows very much about nuclide therapy, and would prefer I deal only with doc at Theranostics Australia. Unless they have a good reason not to give Ra223, I should go ahead.
There have been more recent posts by men about Ra223, but not many bad reports.
The Ra223 might be my Last Stand against Pca. I have no idea what may come next, but I might get an extra year alive.
Keep well my good Mr Allen,
Patrick Turner.
Xofigo isn't available there?
You ask if Xofigo aka Ra223 is available or not in Australia? It sure is available from Theranostics Australia, along with a good number of other nuclides, eg, Lu177, Ac225 etc.
All these things are administered at several hospitals around Australia and all is revealed at Theranostics Australia website.
Additional medical treatment to stop dry mouth caused by saliva gland damage is not yet available here, and afaik, is still experimental and yet to be trialed fully.
It was interesting where I read that after a number of Lu177 doses, PsMa expression can go low, caused by the use of Lu177. But this it typical cancer behavior where a treatment looks so sure to work very well, and all the patient's mets all generate PsMa so at first all these mets attract Lu177. BUT THEN the darn cancer mets react by mutating to stop making PsMa, so Pca can continue growing, and it makes a fool of any smart doctor - "You thought you had me, you white coated nasty dotkta man. Youse ain't got me yet !! "
Wait until I give my bone mets some Ra223
It was a splendid fine warm morning here, and I got a nice 72km cycle ride done at 23.2kph average. Not a single problem.
Patrick Turner.
I misunderstood because you wrote, "But it isn't available therapy yet.
."
Do you know if they tried administering Amifostine (Ethyol)?
My wife is a Head&Neck cancer survivor, going on 19 years now, and she was give ethyol before every radiation treatment to protect the salivary glands. It didn't work but I believe the research indicates it can in some patients.
Seem like something that should be explored if it hasn't already.
It is expensive from what I can recall.
cesces in reply to
TA has a pretty complete list including Amifostine.
Your wife might want to read the article for some after the fact possiblities.
Unfortunately it seems that there aren't any really good treatments. But you never really know until you try them.
If a pluasable treatment exists, weak or strong, it's probably listed somewhere in that article.
in reply to cesces
We have explored and continue to explore options...stem cells seem to provide the most promise.
Yes, interesting piece on msg and Chinese food. I won't have thought of that, thanks for sharing.
Tall_Allen in reply to
Glutamate, like curcumin, is a known heavy metal chelator, that is able to pull the Ac-225 or Lu-177 off of the pharmaceutical, rendering it useless. I added a note explaining this to my article, after seeing your comment. Thanks!
1. Lots of people go out of their way to dose high on curcumin.
2. "Ac-225 or Lu-177 off of the pharmaceutical, rendering it useless"
It's worse than useless. Those loose metal particles are dangerous.
You are right, toxic too, especially the Ac-225
Great summary and analysis TA. Takeaways: 1 make sure you have quite high SUV max in your mets esp if considering Ac225. 2. Combined Lu177 with Ac225 may be more judicious than Ac alone. 3. Eliminate MSG and other heavy metal chelators before treatments.
"high SUV max in your mets"
What is "SUV max"?
Standardized Uptake Values - it's on the radiology report when areas of PSMA uptake are detected on a PSMA PET scan.
Interesting--thanks for posting this!
I'm sure you have seen the damage that lack of saliva can do.
It's not always easy to tell, when you're looking at a mouth with rampant decay whether it's caused by a dry mouth or not. For one thing, patients often perceive that their mouth is dry but when secretion is measured it falls into a fairly normal range. And then again I (thankfully) am just a little too young to have seen much in the way of "radiation caries"--because EBRT for head and neck cancer has been so much improved. But in the one patient I can remember seeing offhand who had radiation for a salivary gland tumor, yes--I'll never forget it. I don't think I've seen patients who've received Ac-225-PSMA-617 therapy
Important, timely and needed. Thanks, Phil
I really don’t think a lot of Chinese restaurants use MSG anymore. Maybe asking about its use would be a little more politicly correct than saying “avoid Chinese food”?
It doesn't matter if they add MSG or not, MSG is naturally occurring in soy sauce and other fermented foods. Many Chinese foods (and other Asian cuisines) contain soy sauce, oyster sauce or fish sauce. Fermented products naturally high in MSG include Kim Chi (Korean), Miso and kelp (Japanese), vegemite and marmite (Aussie and Brit), and stinky cheeses (European). MSG content is also high in such foods as Kentucky Fried Chicken, Chick-Fil-A, Doritos, soups (especially Miso), seasoned salts, processed meats, condiments, frozen meals, etc. If you are getting a Ga-68, Lu-177, or Ac-225 theranostic, I'd avoid Chinese take-out and anything with MSG on the label of additives.
You forgot tomatoes. I hear what you are trying to tell people but none of the nuclear physicians I have communicated with so far advise their patients not to eat Chinese type foods or any other foods with naturally occurring MSG in it because it will make their radionuclide therapies ineffective or less effective. Maybe they are missing something or maybe it is my assumption that if it really mattered they would mention it? Just being the Devil's advocate here. No offense intended.
No offense taken. That trial on MSG is very recent. Maybe email it to your doctor- he probably hasn't seen it. Also, your doctor may not have the chemistry background I do.
Not what you're looking for?
You may also like...
Excellent response to Ac-225-PSMA-617 in South Africa (update)
disappeared. No one discontinued for xerostomia....
New radiopharmaceutical (Ac-225-PSMA-617) has high rates of remission in early trials
in South Africa was among chemo-naive patients:...
Pluvicto damaging salivary glands?
irritation with bleeding, which I attributed to radiation damage. Since then, there has been some,...
Lutetium-177 PSMA-617 (LuPSMA) therapy
Hello! What do you know about Lutetium-177 PSMA-617 (LuPSMA) therapy? Has anyone tried it? What were
Choose Capivasertib or 177Lu-PSMA-617 clinical trial or stick with ADT + radiation?
Meeting with a radiation oncologist next month for a discussion, but thinking about some clinical...
225Ac-PSMA-617/177Lu-PSMA-617 tandem therapy of metastatic castration-resistant prostate cancer
