chemo vs Lu-177

[Cateydid]

good day, warriors:

my Joe had dose 3 of 10 chemo infusions today (second go-round after six doses in 2017)

PSA went up after 1st 2 doses this time. I asked doc to do PSMA. He said no.

now he’s saying let’s try Lu-177 and…oh, BTW, you gotta have a PMSA first…

What the ??

Anyone know if BCBS pays for the test and the drug!

[tango65]

Lu 177 PSMA could be as effective as chemo according to the THERAP trial:

thelancet.com/journals/lanc...

If you decide to go with Lu 177 PSMA treatment you will need a PSMA PET/CT but it will be advisable to get a 18 F FDG PET/CT..

If it is impossible to get a 18 F FDG PET/CT request the SUV values of the metastases and the liver. If there are no metastases with SUV values similar or greater than the SUV of the liver or if there is diffuse infiltration of the bone marrow in the PSMA PET/CT, Lu 177 PSMA treatment may not be a good choice of treatment.

Consider requesting a direct biopsy of the mets to do histological, IHC and genetic studies of the cancer to see if the cancer may be susceptible to treatment with specific drugs or with chemo plus platinum compounds.

[CAMPSOUPS in reply to tango65]

Hi Tango,Thanks again for your inputs to the forum.

The following that I quoted from your reply above interests me.

Was this finding published or somehow common knowledge within the medical field?

" if there is diffuse infiltration of the bone marrow in the PSMA PET/CT, Lu 177 PSMA treatment may not be a good choice of treatment".

It seems to follow the findings that rather than saying not good with diffuse bone mets they say works best with lymphatic mets.

[tango65 in reply to CAMPSOUPS]

Lu 177 PSMA treatment treats the cancer everywhere and it is effective for treating bone metastases.

If there is diffuse infiltration of the bone marrow by the cancer, Lu 177 PSMA may not be a good choice because the cancer cells are in proximity to the bone marrow cells .

The radiation of the Lu 177 PSMA (beta radiation which could travel 3 mm) will affect the bone marrow cells close to the cancer cells and it may cause bone marrow failure.

When there is diffuse bone marrow infiltration by the cancer some centers in Germany treat these patients with Ac 225 PSMA initially and then a mixture of Ac 225 and Lu 177 PSMA. Ac 225 emits alpha radiation which does not travel more than the diameter of a few cells causing less damage to the bone marrow cells.

[Seasid in reply to tango65]

Thanks