it looks like I will finally be able to get Pluvicto soon, but have heard that the radioactivity it leaves in the body can be harmful to others . Do any of you have any information on how to lessen that concern, distance to keep from others, the need to quarantine myself after treatment, other safety measures to take, how long should these precautions be taken, etc.
I think this might have been discussed before, but is there anything that can be done to protect the salivary glands during and after treatment.
Lastly, does anyone know why different providers give da different number of doses? Some give as little as two and others up to six.
Thank you for any feedback you can give me. I’m particularly concerned with protecting my family from any radiation I may may be emitting after receiving this treatment.
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Wish I knew this prior to my four treatments of LU-177 and AC-225 as I have dry mouth.Is there any treatment ,medicine or supplement to restore the saliva gland?
Still was worth it since I am PSA <0.04 and no ADT for twenty one months.
So long as you do not require family members to be direct caregivers (to bathe you, dress you, drive you, etc.) it should be very easy to follow the directives that will be provided to you upon treatment. Most important is distance from kids and pregnant women. The social-distancing is already well-practiced by many of us! Other little details -- like sitting down for urination and flushing twice -- are likewise simple and easy.
My own theory (unbacked by studies or evidence) is that stimulating saliva production during and after treatment might help move radiation through, just as staying hydrated will help the kidneys. I did this (via using dried ginger, gum, etc.) for my first infusion and became quite nauseous several hours later... perhaps because I swallowed, and did not spit, all that radioactive saliva?
For the second infusion I waited to use the gum until I left the facility, and then I spit out most of my saliva for the next few hours rather than swallowing. No nausea. (But I also refrained from a large meal, which I should have done the first time!)
Side effects for me after only two sessions, other than that episode of nausea, have been mild fatigue that lessens several days after the infusion. No dry mouth whatsoever.
Nothing can really protect the salivary glands with small molecules PSMA ligands. It is not an issue with Lu 177 PSMA because xerostomia is usually transitory. The problem is with Ac 225 PSMA which could destroy the salivary glands and produce permanent xerostomia. Severe xerostomia is a life changing event reducing QOL.
My view on this is more conservative than anybody probably. I go out of my way to minimize exposing my loved ones to the radiation I emit and it really doesn't take much effort. Remember that you excrete something like 75% of the radiation in the first day, but if you get the VISION trial amount of 7.4 GBq, that's still 1.8 billion emissions per second on day two. I had my treatments in Germany where their laws say that you can't go out in public until you are emitting less than 23 microsieverts, which is why they quarantine you for a couple of days.
When I came home during the shutdown, I was supposed to quarantine anyway, so I also measured my radiation with a Geiger counter to see when I felt it was safe to be near others. I slept in the guest room until my readings were double the background radiation at a distance of two feet. (The background radiation is what you would read if you set out the Geiger counter and just let it measure the radiation coming in from the cosmos and also emanating from radioactive material in the earth). I typically got doses of 8-9 GBq and it took 10-14 days until I was at that point.
PLUVICTO™ (lutetium Lu 177 vipivotide tetraxetan) is indicated for the treatment of adult patients with prostate-specific membrane antigen (PSMA)-positive metastatic castration-resistant prostate cancer (mCRPC) who have been treated with androgen receptor (AR) pathway inhibition and taxane-based chemotherapy.
IMPORTANT SAFETY INFORMATION
Risk From Radiation Exposure
PLUVICTO contributes to a patient’s long-term cumulative radiation exposure, which is associated with an increased risk for cancer.
Minimize radiation exposure to patients, medical personnel, and household contacts during and after treatment with PLUVICTO consistent with institutional practices, patient treatment procedures, Nuclear Regulatory Commission patient-release guidance, and instructions to the patient for follow-up radiation protection.
Ensure patients increase oral fluid intake and advise them to void as often as possible to reduce bladder radiation.
To minimize radiation exposure to others, advise patients to limit close contact (less than 3 feet) with household contacts for 2 days or with children and pregnant women for 7 days, to refrain from sexual activity for 7 days, and to sleep in a separate bedroom from household contacts for 3 days, from children for 7 days, or from pregnant women for 15 days.
Myelosuppression
PLUVICTO can cause severe and life-threatening myelosuppression. In the VISION study, grade 3 or 4 decreased hemoglobin (15%), decreased platelets (9%), decreased leukocytes (7%), and decreased neutrophils (4.5%) occurred in patients treated with PLUVICTO. Grade ≥3 pancytopenia occurred in 1.1% of patients (including 2 fatal events). Two deaths (0.4%) due to intracranial hemorrhage and subdural hematoma in association with thrombocytopenia were observed. One death due to sepsis and concurrent neutropenia was observed.
Perform complete blood counts before and during treatment with PLUVICTO. Withhold, reduce dose, or permanently discontinue PLUVICTO and clinically treat patients based on severity of myelosuppression.
Renal Toxicity
PLUVICTO can cause severe renal toxicity. In the VISION study, grade 3 or 4 acute kidney injury (3%) and increased creatinine (0.9%) occurred in patients treated with PLUVICTO.
Advise patients to remain well hydrated and to urinate frequently before and after administration of PLUVICTO. Perform kidney function laboratory tests, including serum creatinine and calculated creatinine clearance (CrCl), before and during treatment. Withhold, reduce dose, or permanently discontinue PLUVICTO based on severity of renal toxicity.
Embryo-Fetal Toxicity
The safety and efficacy of PLUVICTO have not been established in females. Based on its mechanism of action, PLUVICTO can cause fetal harm. No animal studies using lutetium Lu 177 vipivotide tetraxetan have been conducted to evaluate its effect on female reproduction and embryo-fetal development; however, all radiopharmaceuticals, including PLUVICTO, have the potential to cause fetal harm. Advise male patients with female partners of reproductive potential to use effective contraception during treatment with PLUVICTO and for 14 weeks after the last dose.
Infertility
The recommended cumulative dose of 44.4 GBq of PLUVICTO results in a radiation-absorbed dose to the testes within the range where PLUVICTO may cause temporary or permanent infertility.
Adverse Reactions
The most common adverse reactions (≥20%) occurring at a higher incidence in patients who received PLUVICTO plus best standard of care (BSoC) were fatigue, dry mouth, nausea, anemia, decreased appetite, and constipation. Clinically relevant adverse reactions in <5% of patients included dry eye, vertigo, and pancytopenia (including bicytopenia).
Laboratory Abnormalities
The most common laboratory abnormalities that worsened from baseline in ≥30% of patients who received PLUVICTO plus BSoC were decreased lymphocytes, decreased hemoglobin, decreased leukocytes, decreased platelets, decreased calcium, and decreased sodium.
Make that 3 deaths due to intracranial hemorrhaging. I was the Caregiver of a patient with Stage IVb that only had ONE Pluvicto treatment just 4 short weeks ago. He passed away yesterday after the sudden intracranial hemorrhaging was found, which was found 6 days before his passing. His radiation oncologist happened to also call him early on the day that we found the hemorrhage and tell him based on his MRI results from the day before he could no longer receive Pluvicto and referred him to a Neurosurgeon but never said exactly why or the severity of the issue. He was taken to ER that night where they said the bleed was to extreme and there was nothing they could do to stop the hemorrhaging or reverse the damage it has already done. To take him home, keep him comfortable, and let him pass. It took 6 pain filled days for that to happen. All of this happened very sudden with no explaination. I'm not sure if anybody understands exactly how it happened. There was no head injury, no fall, NOTHING to cause the bleed to start! PLEASE PLEASE USE CAUTION AND INCREASE YOUR COMMUNICATION/LAB DRAWS/IMAGING TESTS IF YOU ARE/WILL BE RECEIVING PLUVICTO!! This was our personal experience and just my personal suggestions. Closely communicate EVERYTHING with your medical team & support system!
Thank you for this information. I will not be hospitalized after the treatment. Any idea how long it takes to have the radiation fall to a permissible limit and how that is tested ? I plan to “quarantine “ myself but am unsure for how long. Also, do you know if radiation from my body lingers in spaces I have been in. For example, if I am in a room or a cad and then leave, is it safe for others to enter that space?
Hi, I am/was a Caregiver to a man that had started Pluvicto treatment. He only had 1 dose before his unexpected passing due to a rare but serious side effect of Pluvicto. This is what we did to protect myself from the radiation he emitted after treatment. He was no longer able to drive long distances and the treatment center he choose was about 2hrs from where we lived so I drove and he sat in the back passenger seat to give us the 3ft separation space they recommend. Also, we ordered a relatively inexpensive lead vest (like they use in the dentist office) from Amazon and I tied it to the headrest on each front seat to give us extra protection since we would be in close proximity to eachother for the 2hr drive back home. He showered daily, I washed his clothes in hit water with an extra rinse cycle everyday. Had zero physical contact with him or anything that could have bodily fluid on it ie: eating utensils, clothing, drinks and/or cups he used. Pluvicto is processed thru the kidneys and the body expels it primarily during urination so I got him the disposible wand toilet cleaner and he used one every time he had to go to the bathroom (which was alot b/c you are supposed to double your fluid intake), we boiled his toothbrush after every use and he cleaned out the bathroom sink with a clorox wipe after each use. He lived alone so didnt have to worry about sleeping in seperate rooms but that is a big precaution the Dr told us. Basically social distance and disinfect/sanitize anything that may have any type of bodily fluids on it. Its the 3x3 rule, 3ft away for 3 days. If there are children, ovulating females, pregnancy, or males that are still possibly child bearing age they need to keep their distance for 7 dayd as it can cause infertility and reproductive organ cancer down the line. It wasnt hard to do, kind of just like Covid precautions we all took not to long ago. My more important advice would be to carefully watch your labs at least twice in between each Pluvicto treatment. Any drop in your blood counts or platlets see your Dr immediately! It can cause intracranial hemorrhaging if all 3 blood levels drop. That is what happened to my client and he passed away 1 week ago yesterday from that specifically. Just pay close attention to how you feel and your labs!
I hope you have a successful outcome with Pluvicto, it sure sounded like a great treatment.
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