UL177 - How effective is it? - Advanced Prostate...

Advanced Prostate Cancer

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UL177 - How effective is it?

GTOGuy profile image

I'm considering UL177 from Dr. Hartenbach in Vienna. I have metastatic Prostate Cancer which has spread to my hip/femur bones. I have done Lupron, several of the cancer drugs, radiation several times, Immunotherapy and Cryotherapy.. Any feedback on how effective UL177 is for Metastatic Prostate cancer in the bones? Looking for information from anyone who may have done this treatment.

Thank you

43 Replies

Yes, Lu 177 PSMA treats bone metastases and metastases anywhere in the body, if they express PSMA in a PSMA PET/CT. It has been shown to prolong life in patients who have failed ADT, the new anti androgens and one or two rounds of chemo.

thank you - I see that it was approved in the US in March of 2022 but cannot find any doctors that are performing this procedure in the US. The Vienna doctor requires a minimum of 3 treatments each 4 weeks apart which is going to be difficult to navigate not to mention very expensive. thank you for your feedback....

Yorkielover2 profile image
Yorkielover2 in reply to GTOGuy

We are looking at it in Nashville Tennessee!Will have more info end of week!

GTOGuy profile image
GTOGuy in reply to Yorkielover2

Thank you

I have extensive bone mets and am doing the Lu-177, but too early to know effectiveness for me. If there was not hope for improvement of bone mets, as relayed by my doc and many members of this forum, I would not be doing it.

Some suggest an FDG scan to get a better idea of the potential for success. ( did not get one because I am in a clinical trial.)

tango65 profile image
tango65 in reply to noahware

It also depends on the PSMA expression of the metastases. A median SUV less than 10 or lower than the liver may be associated with poorer outcomes than in patients with a better PSMA expression.

GTOGuy profile image
GTOGuy in reply to tango65

Thank you

Seasid profile image
Seasid in reply to tango65

And as you already said the tumor volume should be under 200 mL as per Hofman's team finding.

Seasid profile image
Seasid in reply to noahware

Can you explain why they don't allow FDG scan if you are in a clinical trial?

noahware profile image
noahware in reply to Seasid

Sorry, I did not mean to imply that I asked and they refused to allow it, just that it was not part of the trial. I'm sure I could have paid out of pocket to get one... but I had already decided to enter the trial before understanding the full ramifications of what the FDG could do when contrasted with the PSMA-PET.

(Call it wishful thinking or unfounded optimism, but once I was randomized to the Lu-177 arm, I wanted to believe it would work for me... but I am not recommending that sort of blind faith to others as if it was the most rational way to proceed!)

Seasid profile image
Seasid in reply to noahware

I agree. It was like trying your luck.

So they didn't know that they could select people better for success? Or that they just didn't care? (They just wanted to get enough people?) Or that that was part of the study that they wanted to see on humans the effect of the radiation on the cancer? What do you think what was the reason for that (negligence)?

Do you have a link for that clinical trial?

noahware profile image
noahware in reply to Seasid

My own belief (not confirmed, though, just a guess) is that they really want more numbers of men participating, as soon they can get them. But on the other hand, it makes no sense to me that they wouldn't want to get only the men who are most likely to succeed with Lu-177-PSMA by ruling out those with FDG discordance! As it stands, by including a certain number of those men who are sure to fail, the results of the trial will be less impressive, won't they?

Ramp7 and I are both in this Novartis trial at the Dana Farber (Boston) location:

clinicaltrials.gov/ct2/show...

According to the VISION Phase III Study based on 839 patients with Castration Resistant Metastatic Prostate Cancer, it gives you about 4-5 extra months. But the good news is it supposedly doesn't have a negative effect on quality of life. PSMA Radioligand treatment is in its infancy. Who knows how rapidly they can increase the treatment efficacy in the near future for both recurrence in earlier and late stage disease.

nejm.org/doi/full/10.1056/n...

Bangkok profile image
Bangkok in reply to jazj

Infancy in North America but they have been doing it for over a decade in many parts of the world.

Lu177PSMA617 is approved in the US for men who've had chemo and at least one 2nd line hormonal agent

Wylhare profile image
Wylhare in reply to Tall_Allen

We were at the oncologists office in Indiana yesterday and he said there is no Lu177PSMA617 in the US due to manufacturing issues. There are only waiting lists. Has anyone else been told this?

Tall_Allen profile image
Tall_Allen in reply to Wylhare

Yes, it's a global issue.

luis85715 profile image
luis85715 in reply to Wylhare

IT IS TRUE PROBLEMS AT THE MANUFACTURING PLANT IN NEW JERSEY AND ITALY WITH ISOTOPOS CONTAMINATION, DOSIS ARE BEHIND SCHELUDE OR DELAY, I STILL WAITING FOR MY 4th DOSIS, NO DATE YET. SO FAR TREATMENT WAS WORKING FINE.

Wylhare profile image
Wylhare in reply to luis85715

I am so sorry to hear that. I asked the doctor if it would be back in stock in time to help my husband and he said he didn’t know.

Hi, I just finished treatments with him, here is my report healthunlocked.com/advanced...?

I’m going for 8 days spiritual retreat tomorrow morning and will not be checking HealthUnlocked , so if you have any questions, please ask them today either here or through private messages after you read my report above.

Nusch profile image
Nusch in reply to CurrentSEO

Will you do Vipassana?

CurrentSEO profile image
CurrentSEO in reply to Nusch

No, Iboga only this time, now in the retreat and going of the greed till 28th.

Hi thereI am doing 177Lu-617 currently— just done second infusion at Webly Hospital, Brisbane, Australia under Dr Wong who has been utilising this therspy since 2016. He advises patients that effectiveness is between 50-60%.. concordance between FDF. And PsSMA/CT scans is required. That is most tumours need to express a reasonably high level of psma. Im sure others can provide more detail

Cheers

MarkEmrys

jazj profile image
jazj in reply to MarkEmrys

What does "effectiveness 50-60%" really mean in real-world patient outcome terms? The word "effectiveness" is a very general term and how is the 50-60% measured?

I received Lu 167 PSMA 617 treatment through the early access program, with mixed results.

My scans showed good concordance (overlap of PSMA expressing and non-PSMA expressing cells). My PSA and ALP continued to rise during treatment so we stopped after 3 treatments. Subsequent scans showed that the treatment had killed the cancer in areas with PSMA expression, but new cancer was growing in other bones.

The VISION study showed about 1/3 not having a positive response, and unfortunately I was part of that group. My cancer is very aggressive and I failed all SOC treatments within a 1-1/2 years of diagnosis, so my experience should be viewed with that in mind.

jazj profile image
jazj in reply to Javelin18

I'm just curious if you tried any synergistic combinations of alternative medicines (natural substances) to date? Such as a regimen of 5g modified citrus pectin (aka Pectasol-C) 3 times a day combined with pomegranate extract, curcumin, and green tea extract? Not saying this is curative but just throwing it out there as an example of the kinds of things I'm talking about. I know a lot of people here may see "been there done that."

There's also a book by a well-known Biochemist caked "Beyond the Magic Bullet - The Anti Cancer Cocktail" Again, not likely a cure, but I would expect people at a late stage would be very open minded.

amazon.com/Beyond-Magic-Bul...

Javelin18 profile image
Javelin18 in reply to jazj

I did use additional supplements to help with the effectiveness. I took quercitin, green tea extract and aberaterone during my Lu-PSMA treatment. I couldn't see any effect from these and no longer take the supplements.

What is lutetium PSMA therapy?

You may be offered lutetium-177 PSMA therapy (lutetium PSMA), or Prostate-Specific Membrane Antigen therapy if you have advanced prostate cancer. It’s a type of Peptide Receptor Radionuclide Therapy (PRRT).

Lutetium PSMA therapy aims to improve your symptoms and reduce the size of your tumours. It can also slow their growth. Afterwards, some people experience a long period of remission, but it doesn’t cure your cancer.

It’s used when cancer has metastasised (spread). It can help when other treatments have failed, are causing significant harm or side-effects.

How does lutetium PSMA therapy work?

PSMA is a type of protein found on the surface of a cell. It’s located on the prostate gland, some tumours, and normal tissues.

If you have prostate cancer, you’ll have more PSMA than normal. If the prostate cancer has spread to other parts of the body (metastasised), the PSMA will also be there.

Lutetium-177 PSMA therapy uses a molecule which attaches itself to the PSMA receptors on the cancer cells.

Before it’s given to you, the PSMA molecule is bound with lutetium-177. This is a radioactive substance that damages and destroys the prostate cancer cells in a targeted way.

The PSMA molecule transports the lutetium-177 direct to the tumour site. That means the rest of your body isn’t exposed to radiation.

PSMA TARGETED THERAPY

elvismlv123•

16 hours ago•2 Replies

I found this article in the PC foundation news letter which may be of interest to the group. I know many are aware and maybe using this new technology.

Related Tags

ADT meds, anti-androgen therapy

But the doctors have a job to EXTEND life and prevent cancer progression, rather than a job to IMPROVE a life that might end up being marginally shorter as a result of pursing those improvements.

.You should discuss having a PSMA PET/CT when the PSA is around 0.5. If the clinical trials are not suitable for your situation, you can get a PSMA PET/CT for $ 2800 at UCLA. UCLA Nuclear Medicine. 200 Medical Plaza, Suite B114. Los Angeles, CA 90095. PHONE: (310) 206- 7372. FAX: (310) 206- 4899

UCLA Psma scheduling 310-794-1005

Peter MacCalllum Cancer Institute Ripponlea VIC Australia

Nat Lenzo MD at GenesisCare/ Theranostics AU in Australia. They are less expensive than I've heard for Germany and do outpatient Lu PSMA Tx. Very cordial. Have Skype consult next week.

68Ga-PSMA-11 PET/CT detects prostate cancer at early biochemical recurrence with superior detection rate and reader agreement when compared to 18F-Fluciclovine PET/CT in a prospective head-to-head comparative phase 3 study.

IN 10/05/2012 I had a prostectomy(DA VINCHI). I HAD A gleason 4+3=7/10. MY PSA WAS UNDETECTABLE <0.1ng/ml. bETWEEN 2012 TO 2014. IN 2015 MY PSA start going up WAS 2.4ng/ml and start taking Lupron shot(45mg) every 6-months until today 05/01/2021. I am being prescribed different hormones blocker THERAPIES medications(Lupron, enzalutamide, Zytiga/Prednisone, Provenge, Cabazitaxel, Lymparza. Between 11/19/19-02/25/20 received (4) Quimio Infusion. Between 04/3/20-10/08/2020 received (6)Radium 223 Injection. ON FEBRUARY 22 TO APRIL 22, 2021 Star new clinical trial new medication(SM08502-ONC-01) SAMUMED, LLC, GOT NEW PELVIS/BONE/FACE SCAN (APRIL 20, 2021). ON ARIL 27 DR. GELMAN ORDERED 5 RADIATON THERAPY FOR LOWER LEFT JAW START ON MAY 10.

cancer killing foods like Cauliflower, Cabbage, Radishes, Munakka, , Giloy, Guava, Pomegranade etc. Make sure to tell your mother to put extra spoonful of Turmeric powder, Ginger powder, Garlic and Onion in his moong lentil soup and vegetable curry.

Its Mango season..its OK for him to enjoy some Langada or Dashahari sweet Mangoes as they have good amount of Carotenoids and Vit A.

FDA Approves First PSMA-Targeted PET Imaging Drug for Men with Prostate Cancer

jazj profile image
jazj in reply to luis85715

PYLARIFY PSMA PET Scans (slightly better than the 68Ga PSMA scans) I believe are now covered by most insurance companies. Note the insurance companies pay like $10K-$15K for what a patient could pay directly previously $3K for. Medical costs and insurance premiums in the USA are frankly shamefully high.

But as pointed out (by mentioning the 0.5 PSA level needed for the scan), the detection sensitivity is pretty low below PSA levels of 0.5. If I recall they approach 90% detection sensitivity at PSA of 1 or above. They mainly are used to see if there is any PSMA that the therapy can bind two. If the PSMA scan can detect nothing then the treatment efficacy is negligible and may do more harm than good.

You have helpful information above from luis85715 and others. I recently completed 2 Lu-PSMA treatments with Dr Nat Lenzo of GenesisCare / Theranostics AU. Very good experience. Suggest you request a video consult with him.

Remember that the median extended of survival of 4+ months is just a statistical validation for the single patient at the 50th percentile. Tells nothing about that group of patients (about 1/3) that had considerably better response and longer extended survival (The fat-tail of the curve). That is worth going for IMO.

In the meantime you can request both a PSMA PET scan and an FDG PET scan to confirm appropriateness of this treatment. Also go onto the Pylarify website and locate the nearest treatment sites and get on their wait lists for treatment. Your MO can order the scans and make the referrals.

Australian sites such as GenesisCare and Peter MacCallum do not currently seem to have supply issues. I think their isotope may be coming from Finland. Best of luck to you. Paul

Read my posts. I was lit up like a Christmas tree. My spine almost needed structural repair and now it is completely regenerated. It took 4 rounds however and that's a lot of dough. I had zero previous treatment. Basically I walked in off the street and started treatment.

I know someone else who had a similar response as the post from Bangkok. Never had Psa tests. Passed out then discovered had a Psa in the 2000. Went to India, Fortis Hospital, 4 LU treatments, looking good. Dr Sen in India is a good choice too. Likely cheaper than Vienna.

I went there too, not as powerful a result. I was not on Lupron when I did the treatment and was in early stages of stage 4. Braca2 positive might also have something to do with not as good an outcome. Still it held back my cancer from getting worse for about a year.

Gearing up to start Lu-177 PSMA treatments here in Oklahoma City, Ok. Have been waiting since January when I had PSMA PET to determine eligibility. Scheduled for another scan Friday. The way I understand the treatment is highly effective at killing cancer cells that express PSMA receptors. The over all effectiveness correlates to % of PSMA cells vs non-PSMA cells. Non-PSMA cancer is unaffected.

I have been told by my MO that the product for infusion is in stock at the oncology center.

Also I was told they are starting with Medicare patients.

I am pretty much at the end of SOC options. I guess this will be a last fling and the rest will be up to God.

Seasid profile image
Seasid in reply to bud_manning

Can you please give us more details in your profile so we can better understand your situation. The easiest way out for you would be to find an exceptional medical oncologist. Maybe Dana Farber or similar. It would also help if we would know more about you treatments until now. Where are you treated currently?

My husband is in your situation after having many treatments over 21 years with few options left. I have been trying to get him into Lutetium trials in the US for five years with no luck. He also has Parkinsons Disease, Graves Disease and a feeding tube due to swallowing problems.

He became too frail to travel and we were put off locally for trials due to delays as well as the FDA approval which took him out of a trial-- since September, 2021, so many darn delays giving the cancer time to progress. To finally have him receive it was joyful yet anticlimactic.

He received his first Pluvicto this past Tuesday. He has Medicare and BCBS supplement and it was supposedly pre approved.

Day after he woke up with an odd feeling in his left leg where the cancer is avid. He wouldn't describe it as pain and he is still able to walk. He is quite constipated which is an ongoing battle and may not be related. Through all of his pCa he has been pain free. Only time will tell.

Generally, cancer cells from the prostate express the prostate-specific membrane antigen (PSMA) protein on the cell surface. This membrane antigen serves as a target for certain peptides, so-called PSMA ligands (PSMA-DKFZ-617), which can be radiolabeled with therapeutic radioisotopes like the beta emitter Lu-177 (Lu-177-PSMA-DKFZ-617) or the alpha emitter Ac225 to deliver high dose targeted radiation to the tumour sites. This process is called radioligand therapy (RLT).

The therapeutic molecule is administered intravenously. It specifically seeks out and binds to the PSMA receptors on the tumor cells, and emits local radiation which leads to targeted irradiation of the malignant cells, leading to the cell death. Since the molecule only binds to the tumour cells and since the penetration of the radioactive particles in tissue is only a fraction of a millimeter, the normal tissue around the tumour cells is not damaged, hence this therapy is often called magic bullet therapy.

Various clinical studies show that RLT reduces tumor growth or substantially decreases tumor volume in the majority of cases. The therapy can also reduce pain and PSA values and improve the quality of life.

Typically 3 - 4 doses of lu177 PSMA therapy are administered at intervals of 8 weeks. The injection itself takes about 10 minutes to administer. We hydrate the patient intravenously and the entire procedure can be done as a daycare short admission procedure.

Lu177 psma therapy is very well tolerated. There may be some fatigue in the immediate post infusion period. Some patients complain of some nausea and loss of appetite for the first week or so after injection. There may be some lowering of the red blood cells after a few weeks but the lowering is usually not substantial to need any definite therapy. It usually reverses by itself. The principal adverse effect is xerostomia or dry mouth. Usually the dry mouth increases with consecutive doses and some of it is irreversible. There is usually about 5- 10 % reduction in salivary gland function.

Lu 177 psma therapy is effective in producing a reduction in the tumor sizes and consequently a reduction in PSA levels in about 75 - 80% patients. The duration of response is usually about 1 year, however, there are a substantial number of patients who tend to remain in good response for longer.

Dr. Malik are you thinking of introducing any new RLT's to your clinic? eg. Fapi? Thank you.

Can you please elaborate, what specific information you are looking about ?

Thank you for the information

I had my Lu-177 whilst hormone sensitive ( Dec21/ Jan22/ Feb22) but was doing an unusual ‘triple’ with extensive bone mets and rising PSa. I started Degarelix at the same time which dropped my PSMA by 2/3 in a week pre first infusion so has to get due credit. After the 3 Lu-177 infusions I had 3 Docetaxel ( heterogeneous disease sol a mix up of treatment seemed to make sense ) with Degarelix continuing to starve me of testosterone throughout.

Post treatment scan is in my profile with over 98% reduction - considered a good response. However I immediately started 20 VMAT rounds, had 3 x SBRT to T9 which showed much reduced PSMA but still a mild take up (1.5 SUV) . Finished my 7 months of active treatment with a controversial ‘Brachi boost. Random PSA test post the VMAT and Brachi 1 was 0.12 ( too early but good to see a further drop from my 17.6 in November)

Still not undetectable and I am going to add Apalutamide from Monday to see how I tolerate and let it do it’s thing

I will have no idea in that mix what exactly did what but taking Full scans in November 21 means I have my baseline and everything is about comparison to that.

For me getting back to serious exercise / have a holiday are next steps whilst the monitoring continues.

Good luck with your decision

Just found out today--Lu177 PSMA approved by Medicare provider. I am scheduled for first of 6 treatments July 5. Where are you in US? If backward Oklahoma has it it should be available all over the us.

We had a telehealth visit with Emory doctor today. They won’t be underway with Pluvicto until August so you are ahead of Atlanta in backwards (your words) OK.

Backward Oklahoma: First infusion appointment was canceled. Was told by medical that insurance had not authorized. Was told by insurance authorization had not been requested by medical. Have yet to find someone at medical to tell me who was responsible for requesting authorization, or get it done. yup, that's Oklahoma. I have maxed out on my copay, so they may wait till new year to start.

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