Lutetium Therapy: how effective is it?

[malyu168]

Hi, my husband has metastatic prostate CA and has tried most treatments available. He was diagnosed with Prostate CA in July 2012 and has had radical prostatectomy in July 2012. He has been under hormonal therapy (Luprolex) 11.25 mg for the succeeding 5 years , during which his condition was closely monitored. In 2017, however, his PET scans showed that there are metastases in the prostate bed, lymph nodes and in the cervical spine. He was treated with Xtandi and continued hos hormonal therapy. Flr a while , his PSA was controlled, but he developed resistance to Zytiga and his meds were changed to XTandi. He developed resistance to Xtandi too and he switched back to Zytiga, until December 2020 when his PSA spiked again to 700+ , even going as high as 1000+. He was put under chemotherapy and received 8 sessions of docetaxel chemo. His PSA went down , but not below 500 levels. His chemo was stopped after 8 sessions as no significant changes in PSA levels were seen. He is now back to Zytiga , but after 1 month of taking Zytiga, his PSA went up to 1000+ again. We are thinking of Lutetium therapy but we’d like to hear some real life feedback on lutetium therapy from actual patients who have had the experience of undergoing Lutetium therapy. There’s not much historical data as to its effectiveness here in our country, and we’d like to know if it worked for other Prostate CA patients and if there are any adverse side effects that we should be aware of. Will appreciate getting any response from other similarly-situated Ca patients. Thank you .

[GP24]

I think a trial is more informative than patient reports:

urotoday.com/conference-hig...

urotoday.com/video-lectures...

[Hidden]

I agree with the above about clinical trials being more valuable than anecdotal evidence from the forum.

Here's a useful video on LU-177.

urotoday.com/video-lectures...

[tango65]

I also agree with GP that clinical trials are more informative. This link has some info about the randomized control trial (VISION) of Lu 177 PSMA treatment in clinical advanced patients:

nejm.org/doi/full/10.1056/n...

For what is worth, my personal opinion is that the effectivity of Lu 177 PSMA depends on how advanced the disease is. The treatment can prolong life for several months in patients who failed chemo and anti androgens, indicating an overall survival advantage. It may be more effective if it is used earlier in patients with few metastases and mainly lymph node metastases.

The most significant side effects are caused by bone marrow suppression in patients who have diffuse bone marrow infiltration by the cancer, since the Lu 177 PSMA will destroy the cancer cells but also affect the adjacent blood cells progenitors. The PSMA PET/CT will show if there is diffuse bone marrow infiltration. A center in Germany consider these patients not eligible for Lu 177 PSMA and they use Ac 225 which is supposed to affect less the healthy bone marrow cells.

There are clinical trials for Ac 225 and also for thorium 225 in the USA:

clinicaltrials.gov/ct2/resu...

clinicaltrials.gov/ct2/resu...

In Australia they use a 18F FDG PET/CT scan to determine what % of the cancer is PSMA positive. If there is a high proportion of cancer which is not PSMA positive they do not treat the patients with Lu 177 PSMA treatment, since these patients have a poor prognosis.

pubmed.ncbi.nlm.nih.gov/314...

[NotDFL]

Just search the forum for 'personal' experiences. There are quite a few. But I agree that published studies are (a lot) more relevant.

[j-o-h-n]

We have a few Pinoy members who are here in the US and in the Pines. You may want to touch base with them.

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 08/28/2021 10:40 PM DST

[GregHouston]

I decided not to wait for the FDA approval and went to Fortis Memorial Research Institute in New Delhi for LU-177 treatment this year. This treatment has been available in Europe for a number of years already. I had 3 infusions and the scans now indicate no evidence of disease in the prostate or lymph glands. I made a video of my doctor explaining the treatment scan results. Here is the link: youtu.be/MI8yKRm0HTc(Not working as expected?) If you want more information on the treatment in India, here's a link to Fortis: nuclearmedicinetherapy.in Dr. Isita Sen has been working with Lutetium-177 for many years, so she knows how to gauge the dosages for the best possible outcome.