Hello
Starting Lutetium-617 therapy this week at Wesley Hospital Australia.
They are using a relatively high dose spaced 8 weeks apart.
Wondering if anyone wants to share their experiences on this therapy?
If people are interested happy to post my experiences. I’m m1 with around 5 bone only mets, fast (1 month) PSA doubling time, continuous ADT, post docataxel, RT and SBRT.
Cheers Mark Emrys
Hi Mark, I had 2 Lutetium treatments at Macquarie University in sydney few years ago & it worked well for me. PSA was 19 down to 1.6. Unfortunately it did not keep it down,Let us know how you get on.
Hi Mark, We are the same age and my name is Mark. Fifteen years ago the robotically assisted prostatectomy was performed. A year after that 34 sessions of radiation to knock out left over cancer. PSA slowly advanced for almost ten years, then a rapid advancement in PSA. Doubling time 3 months. First Firmagon, then Lupron with Zytiga and 5 mg prednisone. That was over two years ago. Just had my third infusion of Pulvicto "LuPSMA617" in the phase three trial at Dana Farber. PSA has receded from 8.1 to 0.48. Still on Lupron. Fatigue is the biggest impact on me. I hike 3 miles each day with our Border Collie in the morning. The dose I receive is 7Gbq, 6 weeks apart for a total of 6 sessions. Dana Farber does a very slow administration of Pulvicto. Almost an hour for the stuff to be injected. They find fewer immediate side effects in this manner. I have read in Germany, its a simple injection. Good luck with treatment.
I had a cycle with 8 Gbq. Just a bit of dry mouth and slight fatigue. The trend is to apply higher doses now because this apparently does not increase the side effects.
Would love to follow your course.
Would love to be able to follow you course of therapy if you feel kind enough to share this valuable information.
I too would like to follow your Pluvicto treatments. I seem to be headed that way and am concerned that the salivary glands could be permanently affected. Have they talked about measures that might work in protecting the salivary glands with some form of antidotes?
Mike
G’day Mark. I’m having two doses of 1.5 to 2.0 GBq using the monoclonal antibody ligand, Lu-PSMA-J591, 2 weeks apart very soon (May 13 & 27) in Perth. Much higher binding so lower doses more effective. Just had 2 LNs treated with SBRT, the only ones visible on recent scan. The Lu treatments are to go after all unseen micromets. Good luck. Will report next month.
Hi PaulCould you please elaborate on why you choose PSMA-J591 over Lu 177
They are all using the 177Lu isotope that emits beta radiation (a high energy electron) when it decays. So the “weapon” is the same. The difference is in the ligand, the part of the molecule that has an affinity to attach to the PSMA protein on the cancer cells. The one most used and is the FDA approved Pluvicto, uses a ligand known as 617. So it’s Lu-PSMA-617. Another one that is very similar is Lu-PSMA-I&T. Both of these have rather loose affinity for attaching to the PSMA, they can come off and on. We say relatively low binding coefficient. Because of this you have to use relatively higher doses. J591 is a bioengineered monoclonal antibody to the PSMA protein. Lu-PSMA-J591 grabs onto and holds strongly and persistently to the cancer cell. So you can use much lower doses and seek-and-destroy much smaller targets that don’t even show on the PSMA PET scan yet.
Another difference is in how they are excreted. 617 and I&T are excreted through the kidneys so they have some
Renal toxicity. J591 has no kidney excretion so no toxicity there. It is excreted more slowly in the bile. But because it circulates it can have more
effects on the marrow and cause short term anemia and Thrombocytopenia which can be severe.
177Lu isotope is very expensive and scarce right now. Since the J591 ligand is more efficient it uses much less isotope. 1.5-2.0 GBq vs 6-8 GBq per treatment for 617. And only two treatments two weeks apart vs 4 to 6 treatments 6 to 8 weeks apart for 617. So I can have both treatments during one two-week trip to Australia. And the full cost for both treatments was just $11,000 out of pocket.
Unfortunately i am already committed to Lu-617.From what i can see OS is similR. Might look at J592 (actinium) following
Thanks MateoAre you with Dr Lenzo in Perth?
Sounds a good plan MB. Best wishes.Mark
J591 seems better in every way, why do use the others? is J591 available in USA?
I know 177 Lu TLX591, a monoclonal antibody similar to J591 is available as clinical trial in Australia. But that’s extent of my knowledge.
TLX591 is a kit for preparing Ga68-PSMA for PET imaging, not for treatment with Lu177. FDAApproved in December.
onclive.com/view/fda-approv...
Here is link to the clinical trial I was looking at.
clinicaltrials.gov/ct2/show...
Ended up going with Lu-617 due to neutropenic history with docataxel and resultant fears
Cheers
Mark Emrys
Not in the USA. I checked also with consults at GenesisCare in Windsor, England, Dehli, India and Finland. None have it. Don’t know about Germany. Understand clinical trials are being planned but don’t have any details. Ultimately we will need straight up randomized comparison in different clinical situations.
Here is a small comparative trial on the differences:
Yes, my guy is Nat Lenzo. Don’t know if TLX591 is actually a branded form of J591 or if developed separately.
I understand its a humanised monoclonal antibody derived from chinese hampsters rather than mice by Telix, an Australian start-up. Also associated with a relevant imaging system/protocol…
Very interesting. How did you become aware of J591?
Lu-177-PSMA-617 update- (4 weeks after 1st treatment)
Blood Test - 3 weeks after 3rd LU 177 infusion
Wait time for radiation is 6-8 weeks in BC Canada; will this cause an issue with triplet approach?
Question on PSA rise after starting intermittent therapy 
Further advice please
