I’m looking for any information about lutetium TLX591 which is being used in prostACT clinical trial here. Considering joining this trial vs lutetium 617 (used in VISION trial and the mainstay of lutetium therapy for quite some time here, Germany etc).
Was diagnosed as mCRPC with PSA 5.2 in 2019. PSA doubling every 4 weeks following failure of Zytiga. Now 1.7. Mets in pelvis, scapula and L5. Previous Docetaxel, EBRT and Stereotactic. 68 yrs old hoping to make it to 70.
Any suggestions, information or questions greatly appreciated.
Mark Emrys
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Thanks Allen. You’re right — TLX591 is the same monoclonal antibody as J591. Hoping it’s non-inferior to hoping its non-inferior to lutetium 617…oncidiumfoundation.org/2019...
Hello everyone! TLX591 is a HuX591 monoclonal antibody conjugated with a DOTA chelator and labeled with the radioactive isotope 177Lu = therapeutic rfp 177Lu-DOTA-TLX591. As far as I know, it is in Australia that the 3rd phase of clinical trials of this drug is currently taking place. It would be very interesting to know the results of comparison with 177Lu - PSMA-617..?!
Judging by the complex chain of RFPs, it seems to me that the main task in creating this drug was not so much to reduce toxicity, but to choose a target for destruction..?! And something tells me that the main goal is to destroy both PSMA(+) cells and PSMA(-) cells at the same time.. This information is interesting to study! Thanks to the author for the food for the mind!))
Thank you, Allen, we will study this DOTA-TLX591! I said about PSMA(+) and (-) out of habit.. It would be great if this new drug destroyed all cancer cells in a row!
Hi everyoneA good overview of targeted radionuclide therapy, 177Lutetium-617, 177Lutetium-J591 (which is same as TLX-591) and others is at the following link
Would you please be kind enough to tell us your bio. Age? Location? When diagnosed? Treatment(s)? Treatment center(s)? Scores Psa/Gleason? Medications? Doctor's name(s)?
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Can you have simply 6 cycles of chemotherapy and then reintroduce abitateron (zytiga) again? Your PSA is only 1.7. I would not panic and radiate myself at this point of time. Or you could try Zytiga with dexamethasone. You could keep the big guns for later. I am in Sydney in a Kinghorne cancer center in Darlinghurst, NSW my last psa was 0.44 only on firmagon, stations, metformin and 2 more things.
Thanks SeaDidI must fill out the med history section -- Done the big guns over past 2.5 years -- docetaxel, abireaterone, EBRT and SBRT. PSA progressed following all of this.
PSA at cessation of Abi was 0.4. Also radiographic progression from 2 mets scale and iliac) to five mets still all in pelvis except for one on L5. Doubling now every 4 weeks.Was only 5.2 when diagnosed with mCHSPC, which became castrate resistance in about 6 months.
Maybe chemo would help you. I personally would be very relactan to radiate myself. It has serious side effects. And you will run out of options in the future. After chemo you could try again abi plus dexamethasone. It may work.
Done 6 cycles docetaxel, and would be averse to doing it again. Next chemo is Cabazataxel, or cabazataxel with carboplatin. TheraP trial showed greater efficacy of Lutetium over Cabazataxel...
You're right. I have have spoken to them about clinical trials involving lutetium and immunotherapy but was unsuitable due to low PSA and tumour burden. That was before acceleration of PSA doubling time.Can you recommend someone for a second opinion?
I have a bad feeling that you are pushed into some experiment without real need. You can't have too many cycles of radiation therapy. I would save that for later. I don't know your symptoms and you liver function tests etc. But with 1.7 PSA lot of people would be very happy. I would maybe go 4 to 6 cycles of chemo followed with enzalutamide or something similar. You need an oncologist who will not see in you somebody he can experiment on.
Here is the link about chemotherapy from Professor Fred Saad. My professor R. Epstein advised me to focus only on system therapies. Local therapies can change the PSA but they are not good against the cancer. urotoday.com/journal/everyd...
Thanks for that.I am in process of seeking second opinions on this. I had chemo (docetaxel) plus ADT upfront. 31 months ago, 6 cycles,, with 2 instances of febrile neutropenia -- so a bit wary of another go at Docetaxel. Cabazataxel apparently has fewer side effects and is a prospect; however, the TheraP trial showed better results from Lutetium. See thelancet.com/journals/lanc...
Nevertheless, I take your point. And thanks for the excellent article on chemo.
In a chemotherapy section of my cancer center they said to me at the start of my chemotherapy that I may be switch to the weekly infusion if I have problems with the 3 weekly cycle. (The weekly one is probably milder). Did you get also this information? I am not a doctor but maybe that is also an option? Maybe you can ask about this.
I found an interesting profile for you. He is also in Australia in Brisbane. Looks that he is very friendly. Maybe you can also contact him for information and opinion. healthunlocked.com/user/hansjd
This is a selection from you from Hans from Brisbane:hansjdPatrick-Turner
4 years ago
Thanks for sharing your story Patrick. You're right, the only certainty is uncertainty, but there are many treatments currently available beyond ADT and RT (e.g. docetaxel, abiraterone, enzalutamide, Radium 223, Lut-177) and I believe (and hope) there will be many more in the not too distant future that can help to 'contain' this insidious disease. I remain positive : ) Dare we hope for a cure in the future??
Best of luck with the Docetaxel. I have found it to be pretty tolerable - not a lot of side effects. Day 3/4 after each infusion has been my hardest time - feeling flat both physically and mentally. The chemo regime included 4 x 4mg Dexamethasone the day before, the day of, and the day after the infusion. This cycle (my 5th) I decided instead of stopping the Dexa suddenly I would try tapering it off - first to 2 x 4mg / day for 3 days, then 1 x 4mg / day for 3 more days. The result: day 3/4 were much easier - no flatness - I have felt much better.
My understanding of the Docetaxel is that it kills cancer cells of all varieties, PC and neuro- endocrine, which to my way of thinking can only be good. As per several clinical trials, it has also been shown to extend survival when added to ADT early. My MO put it this way, "short term pain for long term gain", and really the 'pain' has been minimal. Hair has thinned somewhat especially my beard, but so far I have no neuropathy (my wife dutifully ices my hands and feet during the infusion) and I haven't experienced mouth sores (I suck ice cubes). These are cumulative side effects but as I have only one more cycle to go, I'm hopeful I won't experience them at all.
A recent paper says combining Lut-177 with Abiraterone or Enzalutamide increases the beneficial effect and is better done before Radium 223.
eurekalert.org/pub_releases...
So if you go down that route you might consider following that regime. But it seems to me you should give the Docetaxel a chance to work and potentially have a low PSA for months or years with that treatment first.
My guess - you have many more years ahead. All the best.
You sure know how to ask questions, all worth an answer, maybe I can't answer all because every man finds that he will get a different sort of treatment.
For men where there is high avidity for Ga68 in the PsMa scan before Lu177, then Lu177 might be better than any chemo. I had Lu177 right after Chemo failed. My supervising doctor in LU177 clinic for No3 shot of Lu177 was a Pca research doc filling in time between research grants from Govt. She said that although chemo failed, it made my Pca express more PsMa and this attracted more Lu177 thus it more effective, so less shots were needed. But that was a bit late, after 3rd shot, but by final 4th shot, I had been on Xtandi for 7 weeks and reduction of Psa after 4th Lu177 shot was good.
Peter Mac in Melbourne is exploring all sorts of things to do with Lu177, also at St Vincents in Sydney.
But I got a nice extra year year of life with Lu177 which was free of the threat of some other darn treatment that hardly ever works. Without Lu177, I might now be in palliative care.
Psa was 0.32 last November, down from 25 a year before. But now its 10, so action must be taken and I have booked another PsMa scan and Lord Noze what that may or may not reveal, and some of the things in your your list might be tried. Just how well our so called experts know about all these things is not known, so I am bit at their mercy. Ac225 works better than Lu177 for bone mets and probably ALL mets, but its pretty strong stuff and permanent side effect of dry mouth is more likely. So docs have told me they might consider more Lu177 if next PsMa scan showed I'd do good with it again but maybe with with a small amount of Ac225 added. I am presently so darn healthy I'd handle a couple more doses of Lu177 at least.
The dose level for Lu177 is worked out before having each dose, based on what the docs see in scans. If Psa is low, and mets are not large, uptake of Lu177 won't be very high, and using bigger dose won't make uptake much higher. 1/2 the dose is expelled by body in first 24 hours, and its pointless to expose the healthy parts of body to a dose that's too high. Bone mets take time to kill, and its a case of a little bit at a time, and after some initial Pca killings, bone mets change in structure and blood supply so next shot of Lu77 can get in to kill more hard bone in mets again. Its a bit like bringing down a Medieval Castle where you have to burrow under the castle to weaken its foundations, causing a wall to collapse, bit by bit.
I have been told about FDG scans may follow next PsMa scan if needed. I cannot know yet if my Pca could be reduced as much as it was last year by Lu177. All other things are maybe not as good but at this point, I just cannot know yet.
Radium 223 has reputation of making bones brittle, because it is not targeted with a ligand chemical and it just goes where calcium disturbances are happening, which may be where arthritis is happening. Ra223 is so seldom used here I don't know who I'd talk to to find out about it. Its usually used where there are no soft tissue mets and all mets are in bones.
They offered me denosumab every 6 months or zoledronic acid onec a year. I don't have bone pain and my last alkaline phosphatase is 48. I don't understand (I not a doctor) why did they stopped giving you Abi? They could just add dexamethasone and it would still hopefully work? Or they could try to change it to Enza? I am confused. What do you think? If enza would work you would be still hormone sensitive? (Hopefully it is not to do with saving money?)
Off abi as it wasn’t working anymore. Not sure why not continued with dexamthasone. Will ask. Clinical trial won’t allow enzalutimide. But am questioning that…
I have dull bone pain. Do not qualify for govt subsidised enzalutimide as i am castrate resistant and was not forced off abiraterone by adverse responses according to Australian Guidelines. Cost will be approximately $4000 per month.
I have the information from one Australian medical research site that Abi will be available as a generic medication in Australia in 2022 (this year). I am interested in more information about this. In the US the cost of the generic Abi is about 220 US dollars maybe even less. (If I remember well) I would gladly start with Abi now when my PSA is still 0.44 rather than to wait until it is 1.0 as it is proposed. Nobody is prescribing it to me now as they are waiting to put me into a clinical trial with olaparib. I didn't know that if I start this olaparib trial that I can't continue with something else if Abi fails. Plus I don't really want to be on olaparib if Abi works. Can you explain me how did they decide that Abi is not working? What is your trial? What was the reason that you had all the possible radiation therapies? Maybe that is confusing your psa. Hopefully it will stop rising. Maybe you need a little bit more than a simple ADT. Maybe you could try firmagon?
Did you want to stop Abi or your oncologist refused to prescribe? I was going trough some clinical trials results with Nubequa (Bayer medicine) and after 4 years all of them stayed hormone sensitive or died. The survival rate was 63 %. As i said nobody stopped the medication except if they died. I am not a doctor but I wouldn't stop Abi until my PSA would stay under 5. I definitely wouldn't stop Abi with PSA 0.5. but again. Your PSA is still only 1.7 . You are doing well without Abi.
I am not qualified to advise on what you should do. I can however answer your questions. In Australia abiraterone is $45 at the subsidised rate — you have to have progressed on first line hormone therapy. In my case i had progressed on Firmagon. Had embrt at my own initiative straight after chemotherapy because of papers that indicated multimodal therapy is beneficiay. Had sterotactic after further progression on two mets in hip. Recommended by MDT meeting and based on research that says stereotactic is effective in oligometatastic settingCheers
I want to find out the information when will the generic Abi arrive to Australia and how much will it cost. The pbs only pays for the Abi if conditions are fullfield. How much will be a private script for the generic Abi when it arrives. In US it is about 220 us dollars. I know somebody from Pakistan. He was using a generic medication sourced from India long time ago. In Australia if you don't qualify for pbs than you are paying the full price. And that is about 3500 Adollars for Zytitiga. For that reason a generic Abi would be great. I hope it will come soon. I didn't understand how did your doctor work out that Zytiga stopped working? PSA 0.5 sounds great for me. I am confused.
I really don't know, but I would like to find out more when to stop Abi. I just realized that you are on prednisolone or prednisone. I personally think that was prescribed to you with Abi. I didn't want to take prednisolone even when I was doing chemotherapy. Does it help you? I think i wouldn't sleep well. I have to admit maybe it is a good idea... What is your experience with prednisone?
From UK cancer research site: ‘If you're having anti androgens and your PSA level has started to rise again your doctor might get you to stop taking them. In some cases this can cause the cancer to shrink and stop growing for some time. This is called anti androgen withdrawal response (AAWR).’I assumed that i was taken off abi as i was progressing on it — rising psa and more bone mets. Another assumption-still taking prednisone to protect adrenals. But I don’t really know. Will ask Tuesday when i see oncologist again. Will let you know. Btw — i am definitely castrate resistant
There are different treatment options for when hormone therapy stops working, such as chemotherapy or steroids.
You know more than me. I am just getting my Degarelix, metformin, statin, doxycycline 100 mg per day and 300 mg Aspirin (I am not recommending the last 2.) And here I am after 4 years after my diagnosis with last PSA 0.44. nadir was 0.12. I refused to take bone medication. And I am not scanning myself. I hope we will get generic Abi soon so I am not on the mercy of the government. (The pbs rules are not humane.) What was your Gleason score? My was 4+3.
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