Need help XOFIGO vrs Pluvicto

[Jamesjohn63]

I have an appointment to input me for Xofigo but meanwhile I found a Cancer Center that has Pluvicto. Interested to hear what you would do in this situation and why.. Additional info, I have mets in my L2 and pelvis. Thank you and God bless all my brothers with stage four

[Yadifan]

Our MO initially planned on Xofigo for my husband, but with the FDA approval of Pluvicto he fought hard in that direction instead. This information may be dictated by clinical trial procedures, but our MO stated that Pluvicto can not be given after Xofigo. Please make sure with your medical team before proceeding if you're planning on Pluvicto. I do believe that (among other things) chemo is required before Pluvicto. You may also want to talk to them about chemo.

We struggled so for many months on what direction to go. Almost did Xofigo, and for us that would have been a good direction to go. These decisions are difficult. I hope you have the kind of relationship with your doctor that will help you with this.

God bless you too Jamesjohn. Keep us posted.

[Jamesjohn63 in reply to Yadifan]

Hi Yadifan

I was on Decetaxal almost two years ago. Oscar Goodman my cancer doc could not find Pluvicto so he went towards Xofigo

[Yadifan in reply to Jamesjohn63]

I'm not sure where you are, or if your insurance would cover out of state treatment, but we're at Banner in Gilbert, AZ.

A couple of months ago we were leaning toward Xofigo as my husband has bone mets - no soft tissue involved (at least that anyone has seen on any test results). Our reasoning - along with our doctor leaning toward Pluvicto - was that we could have treatment with Xofigo after Pluvicto and not the other way around. It gave us one more treatment in our tool belt. But aside from that, we see many here that have had good results with Xofigo.

A couple of months ago I posted here with a similar question to yours. One reply was that you go with the best treatment that's available to you at that time. That one stuck with me. So simple when you're so conflicted.

[Jamesjohn63 in reply to Yadifan]

I have a meeting /orientation Wend for Xofigo. Then we received a call back for a place where I live in Utah that has Pluvicto...if Pluvicto is better 1st then that makes more sense given both are now available to me

[EdBacon]

Keep in mind that Xofigo only treats bone mets and having visceral mets above a certain size will exclude you.

Lu-177 (Pluvicto) had a slightly better overall survival in trials, but it's only by a few weeks. You do need to have a good PSMA expression, but a very high percentage of cancer cells express PSMA.

I'm in a similar situation. My doctor is fairly confident that I'll make it long enough to get Pluvicto so he wants to avoid Xofigo to "keep my powder dry" for Pluvicto. He also wants to limit my current chemotherapy to 10 cycles so my bone marrow isn't too badly beat up. If Pluvicto is still not available when I need it and doesn't look like it will be soon, I would probably go with Xofigo.

If you still have to do chemotherapy, it may hold the cancer off long enough for Pluvicto to become available if you want to go that route.

[Jamesjohn63 in reply to EdBacon]

I hd chemo two years ago. I wonder which one makes you feel more sick/fatiqued?

[EdBacon in reply to Jamesjohn63]

For most, I don't think the two compare in terms of side effects. From what I know, Pluvicto and Xofigo side effects are quite a bit less than Docetaxel chemo (I've been through that), and probably Cabazitaxel too. Though I am finding Cabazitaxel quite a bit easier than Docetaxel.

[Jamesjohn63 in reply to EdBacon]

I have read here where some could not get past fourth Xofigo treatment

[Tall_Allen]

I don't know which is better. Some things to complicate your decision:

• You cannot get Pluvicto soon after Xofigo, but you can get Xofigo after Pluvicto. There isn't a good reason for this - it was just the way Pluvicto was tested and approved.

• Xofigo combines well with a number of other medicines:

prostatecancer.news/2021/02...

• Xofigo only attacks bone metastases, but it attacks all of them. Pluvicto only attacks cancer cells that express PSMA. PSMA expression can be heterogeneous - within different tumors and within the same tumor. Not all patients express PSMA but a lot of them (~80%) do.

[spencoid2 in reply to Tall_Allen]

Something I had not heard before from my MO: I knew that PC cancer cells vary in their expression of PSMA and therefor the likelihood that LU 177 with the current ligands varies as well. The new(to me) thing he mentioned is that there could be non expressing cells near the expressing ones and they may get killed in the crossfire?

[Tall_Allen in reply to spencoid2]

Yes. But it is also likely that Pluvicto will kill the PSMA-avid ones preferentially, thus giving more room to grow and more nutrient supply for non-PSMA-avid cells.

[Jamesjohn63 in reply to Tall_Allen]

You sound like a scientist, where do you do research?

[Tall_Allen in reply to Jamesjohn63]

Not a scientist. Have a degree in biochemistry. Are you a scientist?

[Shams_Vjean in reply to Tall_Allen]

Would you happen to know if there are currently any studies which are assessing whether other therapy(s) in combination with or following Pluvicto might be effective in addressing the non-avid PCa cell growth occurring post Pluvicto? E.g., Cabazitaxel? or Provenge? or Xofigo?

[Tall_Allen in reply to Shams_Vjean]

In the VISION trial, Jevtana was the most prevalent post-treatment therapy. That was true for both the Pluvicto group and the standard-of-care groups. It was sometimes used with carboplatin.

[Jamesjohn63 in reply to spencoid2]

what I a ligands?

[spencoid2 in reply to Jamesjohn63]

a ligand is something that "sticks" in LU 177 treatment it is the part that is attracted to PSMA. i am not an expert on this but remember that there were at least two (maybe m ore) different versions of LU177 with different ligands

[Jamesjohn63 in reply to spencoid2]

is PLUVICTO one of the two? thats what they have for me at the clinic in SLC

[spencoid2 in reply to Jamesjohn63]

i have not been able to find the specifics pluvicto is different from some or the German stuff as far as i know if i get on the trial it will also be pluvicto, i think there was some dkiscusion somewhere that ki can not find that suggested that there might be better iigands? they usually say LU177 or Lutetium and thjen some numbers and or letters that refer to the ligand at least the way i understand it.

[Shams_Vjean in reply to spencoid2]

From: cancer.gov/news-events/canc...

Like a number of other radiopharmaceuticals, 177Lu-PSMA-617 (Pluvicto) has two components: a drug that delivers the therapy to cancer cells and a radioactive particle.

In the case of 177Lu-PSMA-617, the delivery vehicle (ligand) is PSMA-617 (aka, vipivotide tetraxetan), a drug that latches onto a protein called PSMA that is often found at high levels on the surface of prostate cancer cells.

The radioactive component is lutetium-177.

For a more in-depth explanation see:

cen.acs.org/pharmaceuticals...

[William123Cooper123]

Google articles of comparisons.They give excellent detailed regarding the scope and sequence of radioactive elements directly to cells and lesions.

[Jamesjohn63 in reply to William123Cooper123]

did you send a link? I do not see it

[Shams_Vjean in reply to Jamesjohn63]

Check out this one: cen.acs.org/pharmaceuticals...

[Jamesjohn63]

Ha, no I have a degree in marketing/advertising from the University of AZ class of 83