177Lu-PSMA-617 versus docetaxel in chemotherapy-naïve mCRPC: a randomized, controlled, phase 2 non inferiority trial.

[tango65]

"177Lu-PSMA-617 was demonstrated to be safe and non-inferior to docetaxel in the treatment of mCRPC and could, thus, be potentially employed earlier in the disease course rather than being solely reserved for advanced end-stage disease."

urotoday.com/recent-abstrac...

[cesces]

So it's "non-inferior" LoL

[tango65 in reply to cesces]

I believe it is important for patients who can not have chemo, do not tolerate chemo or do not want to have chemo. Nothing to laugh about it.

I am one of those who can not have chemo because significant peripheral neuropathy caused by a previous treatment.

[cesces in reply to tango65]

Just saying it's not so definitive of a finding.

There has to be nuance than that.

[6357axbz]

Thanks tango!

[Brysonal]

My MO said although chemo is part of the recommended SOC for me ( asymptomatic, fit, work full time 58 year old with metastases to the spine) that not many are ever the same again after chemo for their PCa. So my Lu-177 choice instead of chemo is a QOL choice. If it doesn’t help obvs I’ll do chemo but something with less side effects has to be welcomed to the party!

[tango65 in reply to Brysonal]

I agree. I had Lu 177 PSMA treatment before without any major side effects. Some fatigue for 24 hours .

[Hidden]

I'm violently opposed to Lupron (outside of BAT) and chemo. The first reaction is based on data and my own physiological makeup. The second is perhaps emotional. My dad did chemo for colon cancer in 1978 and then in 2000 (22 years and zero progress - the same drug was used and it was the mainstay the last I checked in 2019). I saw what it did to him. My ex-mother-in-law is doing chemo for breast cancer. The last I heard is that she's ready to call it a day and go to hospice.

So, thanks for posting this. I want a plan for when BAT fails. This might be it.

[MateoBeach in reply to Hidden]

Yes, Lu (+- Ac) PSMA treatments would also be my first choice today when modBAT fails. But my only two PSMA nodes were treated with RT so could not do it until more emerge. Have you had recent PSMA scan?

[Hidden in reply to MateoBeach]

I haven't had a PSMA scan. A couple of months ago my MO said that she would authorize it. But she changed jobs and I need to follow up (I have an appointment with her at the start of January).

[Claud68]

Thanks, tango65, it's very interesting !

[slpdvmmd]

Have talked to people in Australia who said lutetium better tolerated in people with other co-morbidities.

[tango65 in reply to slpdvmmd]

These are some of the side effects of chemo:

accessdata.fda.gov/drugsatf...

People with peripheral neuropathy could have problems with chemo. The neuropathy could go from a sensorial neuropathy to a motor neuropathy with a significant effect in quality of life. Then there is the use of dexamethasone or prednisone which could complicate the control of patients with diabetes etc. etc.

[Brysonal]

Further to my 3 month old reply I wanted to add I had 3 x Lu-177 with no side effects. PSA went from 17.6 to. 0.46 ( started Degarelix alongside so no idea what’s done what)

I was disappinted when my other MO in Finland said he’d like to switch to Docetaxel for the last three infusions as I really was trying to avoid chemo.

But I kept thinking of a PSMA negative cancer cell surrounded by other PSA negative cells that the Lu-177 killed but that ‘last man standing’ negative. Cell was surviving!

So I said yes and have had 1 Docetaxel bomb and am fine. A bit tired for a couple of days but danced till 3am at daughter birthday one week after, full day at Cheltenham races yesterday, back to work full time and still asymptomatic ( now 59)

They used the cold cap, ice mits and slippers and PSA is now 0.25

Lu-177 may have done the ‘heavy lifting’ but the Docetaxel may be clearing up any ‘last man standing’ negative cells is how I am coping.

I’ll have the second Docetaxel bomb in 2 weeks and am taking to it one at a time. Tbh if I get side effects I will stop at 2 . I know it’s cumulative impact but by white blood cells are in norms ( did the daily self inject) red blood cell indicators are all a bit off but to be expected and I am eating well so expect a quick recovery to norms here.

Just wanted to balance my earlier comment. So ended up with an unusual 3 early Lu 3 early Docetaxel plan but QOL still primary and taking it one infusion at a time.

Still got the advanced hormone therapy / radiotherapy to prostate decisions to make.

[tango65]

I think it is a good idea to combine Lu 177 PSMA with chemo and if possible direct radiation of the metastases to be sure repopulation for low expressing PSMA cancer does not happen. Unknown territory, but it seems logical to me. Perhaps in the next 10 years will have RCTs about this. They are already doing one with Lu 177 PSMA and SBRT combined. I hope they will do one combining Lu 177 PSMA and chemo.

I wish you the best of luck and keep us informed.