Need opinions regarding sbrt prior to Lu 177

[Jawbreaker]

I’m looking at getting Lu 177 , on the list at Mayo with Dr Kwon while they are working up getting program started . My radiation oncologist feels he can radiate the few Mets I have with a 60/40 chance of completely eliminating them . He likes idea of sbrt prior to Lu 177 . Dr Kwon though wants to hold off on sbrt until maybe after first dose of Lu 177 which he has great confidence in after viewing my psma scan and low cancer load . He is afraid I could go anemic . Radiation Dr disagrees . I reconnected with Dr Kwon and he wants to wait for 2 weeks until making a decision . I think sbrt prior to the Lu 177 sounds perfect , kill the bulk load with the radiation and “ mop up “ with the Lu 177 . Could someone help me , are other Drs treating with the sbrt before or after Lu 177 ? Help , time is short to make decision

[Tall_Allen]

You can always do targeted radiation after Pluvicto.

[treedown]

I think Dr Kwons concerns are valid. Where are your mets? Are they PSMA avid? I would wait for the 2 weeks.

[Jawbreaker in reply to treedown]

Biggest is at T 6 at right shoulder . They completely went away after chemo but have not popped up again . I see where Dr Lenzo in Australia is treating with sbrt prior to Lu 177 with high degree of success . I would like to talk to him but cannot find any contact info despite a thorough search . Also researching this at Dana Farber someone commented . Radiation oncologist( I’ve known him for some time ) is pushing hard . Also one hot node in left pelvic area he does not want to radiate at this time . Need help on this

[treedown in reply to Jawbreaker]

PM MateoBeach he is in contact with Dr Lenzo and doing the same treatment plan for recurrence.

[Jawbreaker in reply to Jawbreaker]

They are PSMA positive but thru reading it seems Lu 177 works better with smaller pockets of PCA . Hate waiting for program at Mayo to get started with the Lu 177 . Small cancer load at this time . If it is going to take to long Dr Kwon wants me to go to Turkey for treatment . He says that’s where Mayo has recommended their patients go for Lu 177 including 2 Drs at Mayo itself . Says treatment there comparable to Mayo as far as quality and inexpensive compared to other places . Also reading about other people using J5-91 and would live opinions regarding that . Feel like this my last good chance to get some remission from this beast . I have a 16 year old sophomore I really want to see graduate high school and I pray to see graduate from college after that I don’t really care what happens . I know that is a long time from now but it is my dream . He is my life . Really feel I need to get this right to have any type of chance . Help guys

[treedown in reply to Jawbreaker]

I understand all that and have a 15 year old son myself. MateoBeach mentioned doing J5-91. He may reply at some point but would be a great resource for you as he is on top of current therapies and off SOC ones as well. What is Kwon going to offer in 2 weeks?

[MarkEmrys in reply to Jawbreaker]

You might be interested inauajournals.org/doi/10.1097...

[tango65 in reply to Jawbreaker]

Try [e-mail] Tel.: [phone]

If you get in touch with him please let me know by chat, what is his opinion about radiating the mets before the Lu 177 PSMA treatment.

[Hidden]

I’d go with kwon’s knowledge personally! I Only here good about him . Good luck ,either way . Breaks its jaw! 🎯

[Fightingformydad]

Jawbreaker, did the Mayo Clinic tell you when Pluvicto will be available? My father was referred there yesterday, and has met all the criteria for Pluvicto, but both Rochester and Phoenix stated they aren’t administering it yet. Thank you!Heidi

[Ramp7]

My situation: Dr. Beltran, Dana Farber. Prior to first infusion I had 5 visits to the Radiation Oncologist for lesions on L4 &5. So that sounds like "targeted therapy". Just had my third infusion. My back can get sore, but I restore cars which can require me doing all sorts of gymnastics in the garage.

[Jawbreaker]

Not sure when Lu 177 is going to start and they don’t either . He sounded very frustrated with the situation . When I asked him would it be 2 maybe 3 months his answer was his best guess was within 1 month . He said a lot was going on behind the scenes to get it cranked up . At the very end of our conversation he said he would recontact me in the next 2 or at the most 3 weeks to let me know the current situation . He is also afraid what if any co pays would be . He stated that may wind up being cheaper to still go abroad for treatment or not he said their were massive negotiations going on right now

[RS265]

There is a basic misconception of nuclear decay at play here. Targeted radiation (sbrt) will likely kill every cell in the focus area. LU177 requires two DNA strand hits to kill a cell and those are random axis (direction) decay events and so not targeted.

LU177 works best for dense cancer cell concentrations and where the targets are so multiple that SBBT is impractical.

[skateguy]

LU177 is currently available at John’s Hopkins Hospital in Baltimore, MD. I would have started treatment but my PSMA scan was negative.

[Jasmann]

I'm with Dr. Kwon. You can always do targeted radiation after LU-177 to clean up.

[CJ4J]

I think this is a case by case decision from Dr. Kwon. My husband saw him Tuesday and he had SBRT Wednesday due to pain. Kwon also recommended that my husband go to Turkey since this will be my husband's 2nd series of Lut-177. He did have SBRT in February as well and it has dropped most of his blood counts, which haven't completely recovered yet. I'm sure they are dropping lower after yesterday. So, that is something to think about. We trust Kwon and have been seeing him since 2018 and he has kept my husband here longer than anyone thought.

[Bronzee]

Would anyone know the cost of LU-177 in Turkey?

[timotur in reply to Bronzee]

Acc to this website it is between $7K-$15K...

us-uk.bookimed.com/clinics/...

[MateoBeach]

Yes, I did send Nat Lenzo contact info by PM. Here is more information:He said you can sequence the SBRT either 4 weeks before or 4 weeks after the two Lu-PSMA-J591 treatments which are spaced two weeks apart. So they can be done in one trip to Australia. There is no longer quarantine requirement, except for Sydney health care facilities, nor entry COVID test required (but will get one anyway).

The J591 ligand has completely different properties. It binds much more strongly and specifically to cancer PSMA. It holds on. So there is essentially no salivary gland toxicity and no renal toxicity as it is excreted by the liver and not the kidneys. Also, the overall dose of radiation is much lower, 1.5 to 2.0 GBq rather than 6.5 to 8 GBq with 617 or I&T.

The downside, and major risk, is bone marrow suppression. Some level of short term anemia happens in everyone and it can be severe enough to require transfusion in 25%. 10% can require platelet transfusion for thrombocytopenia. But they resolve spontaneously, are temporary.

I think this is meant to treat residual and micro metastatic foci. If there is more metastatic progression in the future Lu-PSMA-617 could still be used.

[Concerned-wife]

Thanks, everyone, this is a very helpful discussion.

[slpdvmmd]

I was faced with this very decision and solicited a number of opinion from RO's in this country as well as Germany and Australia. I think the problem with US doctors is that they are way early (or way behind the rest of the the world depending on your point of view) in the learning curve for LU177. Opinions from outside this country were that radiation before, during and after LU177 have all be used without a distinct advantage. I got radiation to the bed afterward would have made just as much sense to me to do before as you have suggested. My impression was Australia seems to have been using these two forms of therapy together to tackle oligometastatic disease for the longest period.

[acuphealing]

Hello! Is Dr Kwon you were referring to in Sydney Australia (Dr John Kwon)?

[Bethpage in reply to acuphealing]

Dr. Eugene Kwon, Mayo in Rochester, MN.

[acuphealing in reply to Bethpage]

Tha k you!

[mikell]

I know a major question here has been availability of LU-177 in the US. I had been following University of Chicago trials and there just had my PSMA PET scan which showed "PSMA avid disease". While my main fear had been that I might not have PSMA expression, in the 90 minute period post infusion period leading up to the scan I developed flu like symptoms about 30 minutes in, mostly in known met areas. This suggested to me that the tracer was attaching to cancerous areas. At any rate, my reaction to the Gallium has been somewhat painful but getting better this third day. I have been scheduled for my first Pluvicto infusion in about 3 weeks, at UofC. They are apparently the first in the Chicagoland area, AFAIK, to administer LU-177. Having failed ADT, Xofigo, Docetaxel and Cabazitaxel, I'm expecting a rough ride. My PCA load appears high. My last PSA was about 600. I'm still on Zytiga and Zoladex although between the two of them my Testosterone had risen from almost imperceptible to 80 (now about 60). At any rate, UofC is supplying LU-177 treatment now.