Can you qualify for Lu 177 without doing chemotherapy and how?

[Shorehousejam]

In the USA, can you get or chose chemotherapy or Lu 177 as a treatment option?

Are there any qualifications?

Instead of doing chemo

can an advanced metastatic prostate cancer patient or a new diagnosed advanced metastatic prostate cancer patient whom had one dose of chemotherapy with a bad reaction get Lu 177

We were not told we had an option to chose…

[Tall_Allen]

They will accept you for Pluvicto if you tried and couldn't tolerate any more chemo, but you also had to have failed an advanced hormonal drug.

[tango65]

My MO says I will qualify because I have a peripheral neuropathy and I do not want to risk chemo and end up with a motor neuropathy on top of the sensorial neuropathy,.

It will take some time before people without having chemo may be covered by insurance. There is a large backlog of people who had chemo and failed new anti androgens waiting to get the Lu177 PSMA. The treatments will start for most of them by the end of September.

[maggiedrum]

I'm hormone sensitive but can't tolerate ADT (like Lupron). My MO said that the SOC in my situation is to continue ADT until I become castration-resistant (no longer hormone sensitive) and then I have to have had therapy with the castration-resistant meds and failed and then had chemo and failed and had more than mild metastasis. I can't get the castration-resistant meds because of the SOC doesn't call for it.

He did say he would prescribe chemo and that it is likely that my insurance would pay for this. He said it was very unlikely that they would pay for castration-resistant meds outside of the SOC and that he would not prescribe it anyway since it is not SOC. He said it would be highly unlikely (as in 0%) that insurance would cover something like LU 177 PSMA therapy. It is mega-expensive so that without insurance it would be pretty much a catastrophic financial hit even if he could prescribe it before the other therapies are tried in order per SOC, and in any case, as noted, he would prescribe it. He did offer to try and find a trial for LU 177 or one of the other PSMA radio-isotope meds. So far, there aren't any trials for which I would qualify AND are also local since they all (most always all) require multiple visits and infusions done by the trial facility and MO's.

I am hoping the SOC will be changed sometime in my lifetime. The insurance companies would not like that though so I expect them to fight it. And there is a shortage of these types of meds so they are trying to put extra qualifications so only those who have one foot in the grave can get it.

[Shorehousejam in reply to maggiedrum]

Thank you for your reply and explanation, we are learning so much. We agree we hope that SOC will change and include more options that already should available . Insurance companies with The FDA and NIH should not dictate health care needs