PSA Increasing on Lu177 + Enzalutamide.

[pka21]

*Previous Treatment* : Abiretrone, 9 Docetaxel, 9 Cabazitaxel....

*Currently on Enzalutamide + Lu177*

PSA was : 22.7 on 2nd Aug

9th cycle Cabazitaxel : 5th Aug ( failed)

So Started Enzalutamide on 28th Aug

PSA : 24 on 9th Sept

lst cycle lu : 23rd sept (Added lu177 with Enza)

PSA : 28.8 on 24th Nov

2nd cycle lu : 1 Dec

PSA : 32.1 on 15th Dec

ALP, HB etc are in normal range. But PSA is increasing continuously being on Enza + lu177. We r yet to do the PSMA scan after Aug ( last scan was before starting Enza). Probably Dr. will do after 3 cycle.

Getting disappointed after seeing father's PSA increasing trend.

Any suggestions please?

Is there anyone whose PSA start decreasing after 2/3 cycle of lu177??

[Javelin18]

I only had my second Lu-PSMA treatment on Friday, so I can’t comment on drop after 2nd or 3rd treatment. My PSA and ALP both went up 50% after my first treatment. My pain is nearly gone and my energy is improved.

The doctors tell me those are much more important signals than PSA or ALP. How are your symptoms?

[db1966 in reply to Javelin18]

Where are you having your lu177 treatment?

[Javelin18 in reply to db1966]

UClA. I just got into the early access program before it was closed to new patients.

[db1966 in reply to Javelin18]

Congrats. Please keep us informed. I just did labs and scans to do an Arrow trial with Hoag in Newport Beach. Im hoping I get the PSMA treatment versus xtandi only. Fingers crossed.

[Javelin18 in reply to db1966]

Hope you get lucky on the draw

[Ramp7 in reply to db1966]

Is there cross over in the event Xtandi fails?

[pka21 in reply to Javelin18]

My father is feeling good not having any major symptoms as of now, Although he is in some pain medicine from past 1 years.

[Tall_Allen]

Ask for an FDG PET scan - it may explain why the Lu177PSMA617 isn't helping very much.

If some metastases show up on FDG but not on PSMA PET scans, you can ask for a biopsy. Maybe there is a treatable mutation?

In India, he can get APCEDEN.

[CAMPSOUPS in reply to Tall_Allen]

In the U.S. APCEDEN equivalent would be Provenge ?

[Tall_Allen in reply to CAMPSOUPS]

They both use stimulated dendritic cells, but apceden incubates them in biopsied tumor tissue.

[CAMPSOUPS in reply to Tall_Allen]

Thank you. Very interesting.

[CAMPSOUPS in reply to Tall_Allen]

I can't begin to know of efficiency differences but would think as a patient acquiring thru blood would be less burden.

[Tall_Allen in reply to CAMPSOUPS]

Not sure what you are saying. The dendritic cells are removed by leukapheresis. After stimulating the cells, they are reinserted into the blood. That occurs in either therapy.

[CAMPSOUPS in reply to Tall_Allen]

That did it. lol. Thanks as always.A lot of scientific reading for me to ascertain what you concisely summarized. Thanks again.

[Javelin18 in reply to Tall_Allen]

I looked for APCEDEN papers. I saw that it was approved following a phase 2 trial. Do you know if there was a phase 3, or if there are papers discussing effectiveness after approval?

[Tall_Allen in reply to Javelin18]

It's only in India.

[Javelin18 in reply to Tall_Allen]

I understand it is only available there. . I’m interested to know if a dendritic vaccine exposed to multiple cancer antigens might be more effective than sipeluecel t. In general , Im looking to learn all I can about topics that interest me, rather than advice on treatment.

[pka21 in reply to Tall_Allen]

Thanks for the response...I will check with my Dr. on FDG scan..

In Aug, we had one PSMA scan, but Dr did not get any feasible site for fresh biospy which they could sent for somatic BRCA/HRR. They will review once they do the scan again.

Regarding APCEDEN, My Dr.'s are not in favour of doing this or they don't know much about this. So unfortunately I am not able to decide.