Can you repeat LU 177 treatment

[shipoo]

Does anyone know if you can repeat a regimen of LU 177 treatments. I may be starting a cycle soon and wonder that in the future I can repeat the cycles if the initial treatment successfully kills off cancer cells, but in the future the cancer continues to spread. Thanks for any info about repeating LU 177 treatment.

[GP24]

You can "rechallenge" with another Lu177 treatment. However, this is usually done if the first regimen consists of two or three cycles only.

[shipoo in reply to GP24]

Thank you for your quick reply and for this information

[shipoo]

Makes sense. Thanks for your input

[Tall_Allen]

Not beyond 6 - it causes too much radiation damage.

[shipoo in reply to Tall_Allen]

Thanks TA. That’s what Nalakrats was suggesting. I appreciate your answer which I believe is definitive.

[Tall_Allen in reply to shipoo]

OTOH, Xofigo can be repeated.

[Ausi in reply to Tall_Allen]

I was told by my Onc that LUT couldn’t be used after Xofigo, do you have any knowledge if this is right, has it ever been trialled.

[GP24 in reply to Ausi]

You Onc is wrong. See e.g. this trial:

ncbi.nlm.nih.gov/pmc/articl...

[Ausi in reply to GP24]

Thanks

[GP24 in reply to Ausi]

Here are further studies:

ncbi.nlm.nih.gov/pmc/articl...

ascopubs.org/doi/abs/10.120...

[Tall_Allen in reply to Ausi]

Your MO is correct. In the VISION trial of Pluvicto, they excluded all men who had had Xofigo. So the FDA only approved its use in men who were Xofigo-naive. Because of the limitations of FDA approval, doctors around the world (almost all countries go with the FDA) are not allowed to give it after Xofigo, except on a clinical trial. However, they can and do give Xofigo after Pluvicto.

[Ausi in reply to Tall_Allen]

Thanks

[CurrentSEO]

My not doctor opinion … you should not wonder … but after two infusions you will know it is working or not based on PSA and scans. After that, if they do work - you decide how many in total you do in first round. You definitely can do at-least six in total if they work for you. With a good time in between you might be able to do more than 6 if they continue to be effective and alternatives available to you treatments are worst on damage and side effects. Also it will depend on the external radiation volume that you did already( if any.).

So do not wonder now can you repeat or not… because now it really does not matter, what does matter … will first two infusion bring desired results PSA and scans wise or not… and more important based on scans should you go for it at all or choose alternative.

Consider doing FDG PET/CT besides PSMA PET/CT prior to starting Lu-177… or be ready to face the consequences of not doing FDG PET/CT.

Best of luck and success with any treatments that you choose👍

[shipoo in reply to CurrentSEO]

Thanks for your analysis

[Carplake in reply to CurrentSEO]

Can you tell me what Lu-177 is?

[CurrentSEO in reply to Carplake]

Pluvicto in The States.

[JolleySprings]

What do you mean by suffering consequences of not having FDG/PET??

[CurrentSEO in reply to JolleySprings]

It means that you are risking repopulation if you have FDG and PSMA avid discordant cancer. You can read my recent post for more info healthunlocked.com/advanced...?

[CJ4J]

Yes, you can repeat. My husband was in the vision trial in 2019 and he had 6 treatments with success and he reached undetectable for about 6 months after completion.

His Dr has him scheduled for Pluvicto the last week of this month at Mayo Clinic. He was approved by the tumor board there and the provider of the drug. We will see how he does for the 2nd time around. He has more tumors this time but they still are PSMA avid. He blood counts have been struggling with the latest treatments. There are no other treatments available for my dear husband, as he has done everything else available at this time. Hoping for the best!!!

[shipoo in reply to CJ4J]

I hope you both find success with this next round of treatment. Thank you for sharing.

[j-o-h-n in reply to CJ4J]

I will be hoping for him too......... Regards to him (and to you too)...

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 06/14/2022 6:13 PM DST

[Steve77755 in reply to CJ4J]

As someone who's also had 6 LU-177 treatments, that were incredibly successful (PSA 65-0.68), I'm looking into another round of txs as the PSA is going back up. Wondering how your husband's second round went... Thanks for sharing! Steve

[MateoBeach]

Two considerations on that:1) can your bone marrow tolerate more? If your blood counts are all good and did not drop significantly from the prior treatments, then it is probably okay to have more in that respect. Pluvicto (Lu-PSMA-617) is largely rapidly excreted in the urine in the first 6-24 hours. Not a severe exposure left for the marrow. So kidney exposure is more the problem with it. Make sure renal function is good (eGFR >60 and Cr <2). The PSMA-J591 isotope I had is not excreted by the kidneys so no renal toxicity. But it stays in circulation longer and affects bone marrow more. Can consider mixing these up based on circumstances. If I need more in future may switch to Pluvicto for these reasons.

2) Will it still be likely to be effective? This should be considered based upon results of both a PSMA and a FDG PET scans verifying no discordant (FDG positive / PSMA negative) metastatic sites.

[shipoo in reply to MateoBeach]

Great info. Thank you for your response

[j-o-h-n in reply to MateoBeach]

Great reply..... thank you....

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 06/14/2022 6:15 PM DST

[shipoo]

Thanks for your input. What about the concern that too many treatments cause too much radiation in a Person?

[Fightinghard]

Assuming Pluvicto works and lowers PSA and slows progression, anyone know how long do the benefits should continue after the 6 cycles are completed?