Progressing on multiple line, Ac225 next ???

[pka21]

53 yrs male

post BSO

Diagnosed metatstatic CRPC

progressed on abiraterone , docetaxel , cabazetaxel

started on enza since aug 21 added Lu-PSMA therapy since Sept 21 (received 3 sessions)

Progression on PSMA scan, 2/3 new bone sites, PSA 22.7 (Aug 21) to 43.3 (Mar 22)

FDG low burden.

started on Tab Honvan 120mg BD with Aspirin 75mg on 21/4/2022

4th 177Lu PSMA therapy 231mCi on 20.04.22 as Ac225 not affordable that time.

Total lu dose : 723 (200,150 150, 231 mCi)

*Current Status:*

PSMA PET/CT - multiple PSMA avid skeletal mets and marrow lesions are noted

-few dorsal vertebral lesions and marrow lesions are newly noted

FDG PET/CT scan - Most of PSMA expressing skeletal lesions show FDG uptake

-new vertebral and marrow lesions also show FDG avidity

-overall progression on both PSMA and FDG scan.

PSA : 41

*Current Plan:*

- 1# of 225Ac therapy with 180-200uCi dose will be preferrable

- if not fesable, can plan one more round of Lu177 or asked to wait for next week for planning in Joint Clinic.

-to continue tab honovan 120 mg BD

Please suggest if anyone has any experience or suggestions ?

[Tall_Allen]

Is Xofigo available in India?

[pka21 in reply to Tall_Allen]

No......

[GP24]

Ac225 will destroy your salivary glands and results in dry mouth. Therefore I recommend a combination of Lu177 and Ac225:

Result of Lu177 and Ac225 combined

[pka21 in reply to GP24]

Thanks...

We took a 2nd opinion with Nuclear Medicine Dr. . After analysing both fdg and psma scan....He suggested to wait and watch and do 3 month followup scans since psma uptake is not very high now and disease is increased on fdg too...

Med onco now planned for Inj Mitoxantrone.

[GP24 in reply to pka21]

Do not take Mitoxantrone, its outdated. Docetaxel is the better drug.

[pka21 in reply to GP24]

We already had Docetaxel 9 cycle in 2020 and Cabazitaxel 9 cycle 2021....Looks like don't have much options left😐.

[GP24 in reply to pka21]

I would repeat Cabazitaxel instead of Mitoxantrone.

[CAMPSOUPS in reply to GP24]

If Provenge is available to him I wonder if adding it to Cabazitaxel would be of benefit?pka21 age is in his early 50's. Sure has been thru a lot of treatment.

[GP24 in reply to CAMPSOUPS]

Yes, he could try Provenge. But this is available in the US only.

If he is progressing on Lu177 I think he should get an Actinium therapy. Maybe Dr. Sathekge in Pretoria can offer that at an affordable rate.

linkedin.com/in/mike-sathek...

[GP24 in reply to pka21]

The All India Institute of Medical Sciences in New Delhi treats patients with Actinium. You could contact Dr. Yadav or Dr. Triphati.

Actinium research in India