Jevtana and Pluvicto

[Beach18]

Happy Veteran’s Day to my fellow vets and Best Wishes to all of the Prostate cancer warriors -

With stage four prostate cancer to the spine, ribs and other bone sites, I’ve avoided chemo so far.

On Orgovyx and Xtandi recently stopped working with PSA rise. I think Pluvicto would be best for me, but it’s unavailable unless I have chemo first.

Onco suggests Jevtana and then Pluvicto if needed. I don’t qualify for any research studies using Pluvicto for a variety of reasons.

Besides going overseas, is there any other way to go straight to Pluvicto without chemo, which I personally don’t have a lot of confidence in - I have multiple medical issues including cardiac disease - and Pluvicto goes directly to the cancer cells, while chemo kills all fast growing cells.

[tango65]

Lu 177 PSMA treatment is as effective or better than cabazitaxel according to the TheraP RCT.

ascopubs.org/doi/abs/10.120...

If you have some other medical complications, peripheral neuropathy, diabetes , anemia, etc, perhaps your MO could get approval for Lu 177 PSMA.

[Beach18 in reply to tango65]

trying everything- may have to have at least one session of chemo to qualify for next treatment

[Tall_Allen]

What about Xofigo?

[Beach18 in reply to Tall_Allen]

had 3 infusions - didn’t see any real effect

[tango65 in reply to Beach18]

I understand. I had to go to Germany in 2016 because Lu 177 PSMA was not available in the USA and most doctors did not know it existed.

[wilcoxsaw in reply to tango65]

What effect and for how long did the Lu 177 have for you and how many treatments did you do?

[leebeth]

My brother is 81, and was nervous to try docetaxel. His MO explained to him that if he only had one cycle, at a reduced dose, that would open the door for Pluvicto. He ended up going 5 cycles and tolerated it well. He will now start on Pluvicto as soon as he shows a rise in PSA.

So maybe one cycle at 80% dose?

[Seasid in reply to leebeth]

I agree with you.

Docetaxel chemotherapy treatment should not be a problem plus you can always stop it anytime you want. I had 6 cycles and I believe it was very useful in controlling my metastatic prostate cancer in my spine.

Some say chemotherapy even less toxic than an ongoing Abiraterone plus Prednisone treatment.

[leebeth in reply to Seasid]

Recent studies have confirmed the many benefits of docetaxel. Glad you received such good results!

[CAMPSOUPS in reply to leebeth]

I'm in Dox therapy now. 2nd of 10 infusions. Had 6 infusions in 2020.

I'm hoping, actually optimistic that its a good sequential therapy at this stage for me. It opens doors to other treatments and the cross resistance benefits seem good enough to cause it to be involoved in "combo" trials.

[leebeth in reply to CAMPSOUPS]

I am scheduled for my last docetaxel (in combo with Cytoxan) this Tuesday. (Breast cancer.) I am not tolerating it neatly as well as my husband did, so I will be glad to have it behind me.

I hope you have great results and sail through the treatments!! Are you icing hands, feet, and mouth? I am cold capping too. Post menopausal women are more likely to experience permanent hair loss.

[CAMPSOUPS in reply to leebeth]

Dox chemo was in the cards for me pretty much regardless so I entered a trial with possibility of combining Ra-223 (Xofigo) with the chemo. I didnt get in the combo arm of the trial but again no loss as getting Dox chemo at this time is good even by itself.

3 years ago for my 6 sessions I did no icing at all and I did get some numb toes and bottom of feet from it. Hair came back but in a different form.

This time around I'm doing the ice bags feet, hands, and ice chips in the mouth.

I still have skull mets so no thanks to ice on my head. I want that chemo to flow freely there lol.

I hope you can have some comfort thru your chemo and get some good benefit. It sounds a bit rough. Mine so far is pretty much as expected. Nothing pleasant about chemo crash though at all. I also get bone and muscular skeletal pain and "jolts" during the 3 to 5 crash days.

[leebeth in reply to CAMPSOUPS]

The Claritin does the job for me, and I double up if necessary. My biggest issue is Gi! I have had to go in for extra fluids and magnesium countless times.

My husband didn’t cold cap either, for the same reason. He looked a lot better bald than I would!

Thank you for participating in a study which helps to increase our knowledge base for fighting this disease.

[CAMPSOUPS in reply to leebeth]

Crazy for me that Clairton just wont do it. I end up carefully dolling out 5-325 hydrocodone in order to sleep.

I am doing better this 2nd infusion as we decided against Neulasta and monitor WBC more and save Neulasta for actual Neutropenia should it develop. So far so good.

[leebeth in reply to CAMPSOUPS]

My husband’s MO doesn’t prescribe Neulasta for docetaxel mono therapy. He just watched his WBC & diff, and we were careful when we knew he would be low.

Ironically, his hospitalization for neutropenic fever occurred when he was on carbazitaxel/carboplatin and was receiving the Neulasta! Go figure!

[CAMPSOUPS in reply to leebeth]

Initially I had thought I might be in line for Cabazitaxel this time around and side effects not as hard. My MO said maybe true that side effects are less but Cabazitaxel is harder on the marrow/blood health than Docetaxel which was new news to me.

[leebeth in reply to CAMPSOUPS]

I knew it was, and his neutropenic fever really underlined that. The only other real difference for him was no hair loss with Jevtana.

[Seasid]

Some phase I clinical trials to consider if you pass the inclusion and exclusion criterias:

clinicaltrials.gov/ct2/show...

[spencoid2]

I am doing chemo which I did not want to do at all. In the us (other than clinical trials of which none are currently recruiting) (i was waiting for several months for one at UCSF but it is unclear when they will recruit. There is a lot of BS paperwork etc to do to get a trial going.

So with the promise from my MO that if chemo is not tolerated or if it just does not work, I can switch to pluvicto. I think there is another LU177 treatment with a different ligand that might be more effective.

[Seasid in reply to spencoid2]

That is true. See my link above.

[ajok]

I saw on the manufacturer’s website for Pluvicto that its only prescribable AFTER having had all the other treatment options - chemo and hormone therapy, external beam radiation, etc. Don’t know that there is any way around this. It very well could be that some practitioner somewhere would be willing to take the shortcut, but I believe a history of treatment needs to be provided in order for the manufacturer to release doses. And, since Pluvicto remains in short supply, it seems to be very much a seller’s market.

Try going to the Pluvicto website to see all the previous treatments they demand. Good luck to us all.

[Beach18 in reply to ajok]

thank you - had one dose of Jevtana which I did not tolerate well at all, and months later am trying to get back to my previous level of activity - but that checks the chemo box - and since Pluvicto is not available in coastal NC, I’m waiting on Duke to see if I can get it there. As you said, it’s hard to get, only one facility in Italy makes it, and there is a 4 month backlog in general before you can be started on it. It’s an odd situation to be in, watching your PSA rise and symptoms get worse while you wait for a drug that is in short supply. Why does it stay scarce when the population of people who need it keeps growing? Logistics or greed - who knows?