Xtandi and LU-177

[Cynthgob]

Husband is considering Lu-177 treatment. Why is Xtandi also so strongly encouraged along with the radium? Isn’t one poison enough? I worry about his energy level. ADT , Xtandi and Lu-177. Will he even have enough energy to enjoy life.

[Tall_Allen]

The hope is that the combination may knock it back further than either alone. Zometa or Xgeva is required with it.

[Cynthgob in reply to Tall_Allen]

Yes he’s on the Xgeva.

[tango65]

Xtandi may increase the PSMA expression making more targets for the Lu 177 PSMA ligand. There is also the hypothesis that the combination will increase the efficacy of Lu 177 PSMA. There is a clinical trial of enzalutamide and Lu 177 PSMA versus enzalutamide alone:

clinicaltrials.gov/ct2/show...

[Cynthgob in reply to tango65]

Where is the trial? Tulane ?

[tango65 in reply to Cynthgob]

This particular trial is done in Australia and N Zealand.

[ellie2211 in reply to tango65]

What about with zytiga?

[tango65 in reply to ellie2211]

I do not have information. ADT alone increase PSMA expression for a while. Most probable zytiga which blocks all sources of testosterone will do the same.

[RyderLake2]

Hello, There is a clinical trial, currently recruiting participants, that is addressing your specific question. It is (NCT04419402). Look it up. There are several German doctors with more experience in theranostics than in North America who believe that Xtandi (enzalutamide) helps with the absorption of Lutetium. One is Doctor Samir Ezzidin of the Universitaets Klinikum des Saarlandes (UKS). He has written several papers on this topic. Finally, Doctor Charles "Snuffy" Myers (now retired) always said in his blog and elsewhere the best way to treat aggressive PCa is through combinations of drugs. My suggestion is go with the recommendation. Hope that helps.

[GP24]

You do not need to get in a trial, just take Xtandi: eurekalert.org/news-release...

[Cynthgob in reply to GP24]

But I need the Lu-177 along with it

[GP24 in reply to Cynthgob]

I understood that you had already arranged the Lu-177 therapy.

[Cynthgob in reply to GP24]

Yes it’s being ordered from Italy where they make it.

[Cynthgob in reply to Cynthgob]

They are strongly recommending xtandi with isotope

[GP24 in reply to Cynthgob]

You will usually start taking Xtandi at least a few weeks before the Lu-177 therapy and continue with it during the therapy. I would recommend to continue taking it for a few months after the Lu-177 therapy trying to improve the results of the Lu-177 therapy.

I think if you get a Lu-177 therapy, you should try to do what you can to make it as effective as possible. Do not worry about the side effects of the combination. Lu-177 is a type of radiation and Xtandi is hormone therapy, so they do not add together for more side effects. It just has been observed that Xtandi increases the PSMA expression of the tumor cells so the Lu-177 ligands can more successfully attach to the tumor cells and radiate them better.

[Hidden in reply to GP24]

My husband took Xtandi and it did not do anything. Would that mean that the LU177 would not work also? He is doing Xofigo right now.

[GP24 in reply to Hidden]

I provided a link to this article above:

eurekalert.org/news-release...

In there it says, even if the patient is resistant to Xtandi, i.e. it does not lower the PSA value, Xtandi will increase the PSMA expression still.

However, as long as you get an Xofigo treatment you will not get a Lu-177 therapy at the same time.

[Hidden in reply to GP24]

Thanks so much. Yes I know you can not do the LU177 with Xofigo at the same time. Right now just trying to find something that helps with the bone pain.

[Michelle56pr in reply to Hidden]

We got rx for Morphine and Vicodin. Both cause nausea and vomiting. If that is the case , request other route of delivery such as a patch, suppositories or injection (if feasible).

[Cynthgob in reply to GP24]

What are your thoughts on adding back some testerone?

[GP24 in reply to Cynthgob]

I do not understand the reason for your question. When you add testosterone, this will not increase the PSMA expression.

[Cynthgob in reply to GP24]

Someone else suggested perhaps to add some testerone to this treatment and wondered if that was ever an option?

[GP24 in reply to Cynthgob]

In your profile I read: "Advanced bone cancer. So far not in organs." This is not a situation to add testosterone. You can use estradiol patches to mitigate most side effects of ADT:

healthunlocked.com/advanced...

[Cosmo3]

Hi,I just return from Germany after receiving my first dose of LU177. I don’t have any results to report yet that I can share with you at this time but I can share my experience. It was very well tolerated with no side effects. I definitely would do it again. It was either this therapy or start chemo for me. Also, some German hospitals like US clinical trials won’t take patients unless they had chemo first.

In order to qualify for this treatment, you have to have PSMA accumulation for it to be successful and good kidney function. They will do a PSMA Pet scan and kidney function scan to qualify you for the treatment. I’m told 90% of cancer patients have PSMA but 10% don’t. I was lucky and had high PSMA accumulation . I spent 2 1/2 days in the hospital before I could be release. Also, returning to the USA, going through customs at DFW airport, I set off multiple custom agents radioactive measurement devices and was detained for 45 minutes until cleared. Before I was discharged a review of my just completed scans showed good results and intensive accumulation of radiation in the metastasis. I’m scheduled for a second treatment on October 4th. The doctors believe I will need just two treatments. If you have any questions, I will try my best to answer them.

My diagnosis:

- prostate cancer with osseous and lymphogenic metastasis

- Gleason score 4+5=9

- medication according to study protocol LAE001/prednisone and afuresertib,

now: ARV-110

- PSA of 480 ng/ml

August 23rd - 1st cycle of radioigand therapy with 6.0 GBq lutetium-177-PSMA

Findings: 48hrs after 1sr cycle, intensive accumulation was found in the known metastasis.

[Cynthgob in reply to Cosmo3]

So did they mention xtandi?? Yes husband has been thru the pet scan and does have the right psma. Also good in kidneys. Have you considered buying a small Geiger counter? I see them on Amazon for $86! Your reporting is great! We have run thru all the treatments as well including chemo.

[Cosmo3 in reply to Cynthgob]

No they did not mention Xtandi. I was on Xtandi for 8 months and it dropped my PSA from 59 to 7 over that time period and then it started to fail and PSA started to rise. I participated in 2 clinical trials and just watch my PSA slowly climb. I withdrew from my ARV-110 trial to try LU177.

[Cynthgob in reply to Cosmo3]

How well did u tolerate xtandi? I’m afraid of that drug but they are thinking it enhances the LU-177?

[Cynthgob in reply to Cynthgob]

Look below on my post!

[londoncyclist48 in reply to Cynthgob]

I've been on xtandi (enzalutamide) for ten months. Personally, I think its side effects are exaggerated. Generally, I feel ok. I read so much online about it before taking it that once I had begun taking it, my brain started convincing me that minor aches and pains were caused by the xtandi. Hospital told me it's a very safe drug. I agree.

[Cynthgob in reply to londoncyclist48]

Thank u!! But taking it with the radium seems like a lot !

[Hidden in reply to Cosmo3]

Can you tell me the cost of doing this?

[Cosmo3 in reply to Hidden]

I went through bookinghealth.com and it was first class service with interpreter and transportation upon arrival and to all appointments. $28k. Next appointment is direct with hospital and should be much less. I’m waiting for cost figures.

[Hidden in reply to Cosmo3]

Thank you so much for the information.

[Dundalk in reply to Cosmo3]

Hi Cosmo3 from Ireland.. investigated Lut-177 only available in London and Germany... 6 sessions 3 scans.. over 36 weeks.. £100,000... no guarantee.. so started min.6 biweekly chemo plus monthly Zometa.. How do you guys justify the expense.. I am sure my AXA policy would not cover this. Where in Germany... maybe I dont need the 6 sessions and therefore affordable! Diagnosed in mexico 7 years ago.. Gleeson 8.. spread to pelvis... many thanks Mike

[GP24 in reply to Dundalk]

If it has spread to the pelvis only you may need two sessions. A session is about 15.000 Euros including PSMA PET/CTs and hospital stay.

[poppymom0211 in reply to Cosmo3]

May I ask what your PSA was before you started LU177? How many treatments did the Doctors in Germany think you would need? Which clinic in Germany did you receive treatment? Good Luck and God Bless!

[Cosmo3 in reply to poppymom0211]

2 treatments. PSA 482. Marburg University Hospital.

[Cosmo3]

Also, if you are interested in receiving treatment in Germany, I can give you the international contact for the Marburg hospital to schedule an appointment.

[lcfcpolo in reply to Cosmo3]

Hello Cosmo3. I'm still hormone sensitive and taking Enzalutamide. Would you be able to share the Marburg hospital information with myself please. Best wishes Graham

[Cosmo3 in reply to lcfcpolo]

Susanne Zapf+49 6421 5866808

Email: [e-mail]

Susanne runs the international office at the hospital and speaks English. Email is a good way to ask her questions.

[Dundalk in reply to Cosmo3]

Many thanks.. great to know.. keep us informed of progress.. cannot believe you cannot get in Andersen or Sloan Kettering etc.. or just prohibitive!

[Dundalk in reply to Cosmo3]

Been in contact with Bookhealth.. a bit of a Boilerroom op but what the hell!!

[Cosmo3]

I tolerated all drugs including Xtandi very well. ARV-110 was my worst. It made me nauseous and I started losing my hair.

[docbulldog]

I was on Xtandi three years ago and then switch to Zytiga after my PSA began to rise. Zytiga did not do much to control PSA it rose to 30 within a year, so I started chemo treatments. I think LU 177 will be my next treatment unless I try Xtandi by itself first.

Best of luck to your husband, it sounds like the combination may be very beneficial. Positive wishes to all.