Zytiga and Lu177? So many confusing q... - Advanced Prostate...

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Zytiga and Lu177? So many confusing questions.

Zhyravlik profile image
18 Replies

Hi everyone!

Father was on Zytiga for 13 month. And his PSA droped from 600 to 64 and stayed there . Then it did go up and down with Prednisone and dexa mixes. Last time PSA was 88 in mid fo January.

But then things got complicated. Our local hospital run out of drug (well we are in Russia, so no surprises here). Then father catch COVID and in same thime some complications from BONJ... so he is recovering from that.

And in same time i manage to put him in trial with Lu177 in Moscow. And if hi will be accepted (we will know for sure next week) they are waiting for him in Moscow 24 of February. And doctors from Moscow hospital wrote me that there is no need to cancel Zytiga. But! We are in Russia, so local hospital in Kaliningrad refuse to give him pills, because of how health system is working. And they say we need to choose line of treatment.

And in Moscow he will be in clnical trial. They don`t offer scans with FDG or GA68 before :( We can make them for our own money though.

And also it that trial they offer dose of 3,8GBq. Bu gap between cycles is only 2 weeks if he will tolerate it well! We can level it up to 5,5GBq for our own money.

so jumping to main questions:

1. should we buy Zytiga for our own money? Wich is better: mono-therapy with Lu177or combined with Lu177 and Zytiga?

2. How importand Ga68 and 18 FDG before starting Lu177? Because of fathers covid we don`t have much time and it`s quite expensive. Can we make them after 1st cicle?

3. Is there eny info about low dose but just 2 week cycles of LU177? Should we stay with 3,8GBq or go with 5,5GBq?

4. And all of this requres a lot of money. On what we should be spending them: Zytiga, scans or more high dose of Lu177?

Katya

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18 Replies
GP24 profile image
GP24

This are difficult questions and there is probably no consensus on how to answer them.

1. Lu177 will work with Zytiga and without Zytiga. I do not know the cost in Russia, but two weeks of Xtandi before Lu177 would be best. This increases the PSMA expression and could make the Lu177 therapy work better.

2. You make the scans before and after Lu177 therapy so you can observe the result. If you do not have the money, you can get the Lu177 therapy and just observe the PSA value.

3. The doctors will try to find out in this trial how two weeks cycles work. I would pay for 5.5 GBq, 3.8 GBy will probably not work well.

4. high dose of Lu177 (I had 8 GBq)

Javelin18 profile image
Javelin18 in reply to GP24

I'll add a few comments to GP24's great answers.

1. In the US Xtandi (abiraterone) isn't usually given at the same time as Lu-PSMA therapy. When the side effects of combined treatment haven't been tested, doctors usually choose to do only one treatment at a time. I'm guessing they would do the same with Zytiga.

My doctor continued me on Xtandi during my Lu-PSMA treatment, because my cancer is very aggressive. For me, there didn't seem to be any benefit to continuing Xtandi.

3. The reason for giving a high dose of Lu is to increase the radiation of nearby cancer cells that don't express PSMA. It sounds like in the trial they are trying to answer if shortening the time between cycles is as effective as higher doses.

One reason for spacing treatments is to allow the bone marrow to recover. The doctors running the trial will probably be watching white and red blood counts closely . Getting high dose and short cycle time could cause enemia, so I would advise you to be cautious with that choice.

GP24 profile image
GP24 in reply to Javelin18

Javelin,

my recommendation was based on the following article and further discussions:

eurekalert.org/news-release...

Katja wrote in the profile: "With uncountable mets in bones". Therefore I think 3.8 GBy is just insufficient. A combination of Lu177 with Ac225 would be my recommendation against bone mets.

Javelin18 profile image
Javelin18 in reply to GP24

Thanks for that information. It looks like he found a synergistic effect.

My doctor and I were following our intuition continuing abiraterone during Lu-PSMA therapy. Since enzalutamide works differently than abiraterone, that combination may be better. It's hard to say from the anecdotal evidence.

I don't know what the side effect risk is from the combination, but my layman guess is that it isn't too great.

I feel more concerned combining with the more standard dose level and short cycle time. The half life of Lu is 7 days, so it will be in body continuously. Anemia is a concern expressed strongly by my doctors, so I like the idea of giving the marrow time to recover.

Of course these are just my opinions. Making the call on how treat is tough for patients and doctors. I try to use this site only to get data and opinions to discuss options with my doctors, and to give others information to help them with their discussions.

Zhyravlik profile image
Zhyravlik in reply to Javelin18

I found this artickle about combining Abiraterone with LUonlinelibrary.wiley.com/doi...

I guess they are going to monitore his blood and will change time between courses acoording that.

Zhyravlik profile image
Zhyravlik in reply to GP24

Thank you for your reply. ☺️

lcfcpolo profile image
lcfcpolo

Hi. It is great that you are supporting your father. You 100% need to message with our fellow member RusLand. Not only is he from Russia he has had the treatment. He can advise you about going to Baku as well. He only the other day was saying 7.4 GBq I think as a minimum. Good luck.

Zhyravlik profile image
Zhyravlik in reply to lcfcpolo

hi. I actually did talk with him. And hi is agains low dose and short recovery period. And he thinks that we should add Ac225. But we don`t have around 8500 $ for each trip there. So we have to deal with what we have.

tango65 profile image
tango65

I believe the most important thing is to use the financial resources to get treatment with a larger dose of Lu 177 PSMA and perform Ga 68 PSMA PET/CTs before and after 2 treatments. The cancer will be treated more effectively and you will be able to see if the therapy is working. ff

irakor profile image
irakor

Dear Zhuravlik Katia! We are also from Moscow, now we live in Chicago area. Please consider Casodex instead of Zytiga. We visited my husband's oncologist today and found out that Casodex is not as strong as Zytiga but it has less side effects (no threat to liver and kidneys) and it's much less expensive. Good luck!

RusLand profile image
RusLand

Hello, Ekaterina! Yes, we communicated with you in private messages, but I will also answer you here, maybe it will be useful to someone. 1. There is not much difference in therapy with the help of the PSMA-617 ligand which antiandrogen your dad will take.. The main criterion is to keep Testosterone at the castration level and the lower the better! This is necessary so that the PSMA(+) cells destroyed by radiation are not quickly replaced by new PSMA(+) cells! 2. I do not understand what prevents you from getting a free referral from your doctor in Kaliningrad in order to undergo these two PET-CT studies in Moscow..?! And if you are faced with the choice to undergo these examinations for your own money, then first of all go through 18F-FDG and it is very important to do this BEFORE starting treatment! This is much more important than determining the status of the PSMA! I have not yet come across any case when this status would be negative for prostate cancer..?! Radioisotope treatment is very serious and if there are a lot of FDG(+) cells in your dad's foci, then you will unnecessarily expose him to a large dose of radiation and possibly further worsen his current condition.. Benefit - Risk! You can send me a file of this study by mail and get a consultation from my radiologist from Baku through me, done for free! 3. I do not know what goal the Moscow radiologists pursue in their research, but they go against the III and phase of the research conducted by Novartis: novartis.com/news/media-rel... It's also surprising to me that they don't even need to be examined with 68Ga -PSMA-11 or 18F-PSMA-1007..?! For a patient with bone metastases, a dose of 177Lu activity of 3.8 GBq is certainly not enough! The concept of radioresistance has not been canceled yet! But the introduction of 5.5 GBq of activity every two weeks is probably also wrong ..?! I can also address this question to my radiologist in Baku, who has been engaged in such treatment for more than 5 years and get his advice.. And it is necessary to understand very well that Moscow doctors are only taking the first steps in this direction and will still learn a lot, including from their mistakes ... 4. The therapeutic effectiveness after each course of therapy with 177Lu can be assessed by the dynamics of PSA, as a rule, after two weeks it surely begins to decline..

P.S. I don't know how correct it will be, but I will tell you that I have two germitic packages of the original Zitiga, which are kept in the refrigerator all the time. But the shelf life of these packages expired in July 2020! If you deem it necessary, I can send them to you at my own expense!

PSA Dynamics
Zhyravlik profile image
Zhyravlik in reply to RusLand

Hi! My father is on a lockdown because of covid. And i hope he will get negative test this weekend. And we have just next week to finish all blood works and etc. So there is very liittle time left and i guess there is line for free FDG in Moscow. But probably we could manage to do it after 1st infusion. I guess there must be some time between FDG and Lu infusion?

RusLand profile image
RusLand in reply to Zhyravlik

If you have the opportunity, then write out two directions from your attending physician according to form No. 057/04-y at JSC "European Medical Center", 35 Shchepkina str., Moscow, 129090. In one, in column 8, write: PET-CT examination with rfp 18F-FDG (this is paramount!), and in the second: Examination with RFP 18F - PSMA-1007. Then call the reception at +74959336652 and try to make an appointment for the date you need. If it doesn't work out with the date, then call me!)) It makes no sense to do a PET scan with any of these RFPs earlier than two months after the extreme infusion of 177Lu, for the reason that the scanner will be blinded by the isotope accumulated in your foci during therapy! As a rule, after the therapy itself, scintigraphy of the whole body is performed on the next day for a SPECT to assess the accumulation of 177Lu in the foci. I want to emphasize once again that without determining the status of the FDG, you can unnecessarily expose your dad to large doses of radiation and possibly worsen his condition!

mmmm1960 profile image
mmmm1960

а где именно в Москве Вам предлагают лечение Лютецием?

RusLand profile image
RusLand in reply to mmmm1960

Russia has not yet offered such treatment, even for money! It is not approved by our regulator! In Moscow, the Institute of Radiology and the Medical Nuclear Center in Obninsk are conducting clinical trials according to protocol 177Lu-PSMA-617 in small groups. And apparently Caterine's dad was called to one of these tests.. My opinion!

Zhyravlik profile image
Zhyravlik in reply to mmmm1960

Да, он сейчас будет участвовать в КИ в Центр Рентгенорадиологии. Но тут несколько нюансов. Не назначают скани ни с Га 68, ни 18 ФДГ. А это основной параметр отбора для такого лечения. А так же в этом КИ малые, но более частые дозы облучения. Если Вы решите поучаствовать, то лучше заранее самим пройти ПЭТы. Будет время между ПЭТ, да и сможете оформить все по ОМС.

mmmm1960 profile image
mmmm1960 in reply to Zhyravlik

А сколько стоит данное лечение? Вы выше писали про какие-то платные и бесплатные дозы. Если не попасть на КИ то можно за плату пройти лечение?

Zhyravlik profile image
Zhyravlik in reply to mmmm1960

Давайте я Вам в сообщении отвечу.

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