Radiation to the same spot and more on trials

[spw1]

My husband had his right hip radiated in March-April 2022 and the left one a week ago. His right hip pain had gone away in the last few months but is re-appearing. Could he have radiation again to the same hip?

We had the tantalising prospect of checking Lu177 availability. He had a PSMA PET scan as part of a screening for trial but they have not shared it with us despite our request. If it showed that he is a good candidate for Lu177 treatment, he could lower the burden of his disease first by Lu177 infusion or two, and then participate in a trial. The exclusion criteria do not include Lu177. At the moment, the blood work is recovering but his pain might stop him from taking part in a trial that involves a weekly infusion in a place 5.5 hours away in the car on British roads. All we heard was that the scan was good; this must mean that he is expressing PSMA - without that he could not join the trial anyway. The trial doctor says Lu177 is always there and that he should join the Phase 1 Potentia (Crescendo) trial. I am not sure how practical these people are even to suggest it to a man in pain. Interestingly, this trial is also recruiting at a hospital 90 m away from us. The market is competitive; so they will not pick up the phone and refer you to one that is nearest to you.

We are now in the frightening and heartbreaking land of no easy treatment option left. He is on slow release MST, paracetamol and Celecoxib with topping up with Oromorph as necessary. He feels that he is worsening rapidly. This is one cruel disease.

[Hidden]

Hindpw1

I have everything crossed for you so that you can get on this new trial.

If it works for you then a 5.5 hour journey will seem like nothing. Where in the UK will you be traveling from?

We are on week 4 of being in hospital. Hubby on his back in bed. Operation next Friday to open up his spine to stop compression. Then hopefully radiation to Mets. Started xtandi 4 weeks ago, psa down only slightly from 150 to 115.

Stay strong, stay positive.

[spw1 in reply to Hidden]

Hi thank you very much. Now the bloods are okay to join the trial but not in a position to travel due to pain. They have to treat him a bit before he can do a weekly infusion journey that far. From the North to Royal Marsden, around the M25 is easy as we set off after I finish work and by the time we hit the M25, it is quieter. Coming back is usually in peak time and it has taken us 8+ hours once to do that journey. It must be very difficult to lie on bed in a hospital. I hope that your hubby has access to some good things to listen to. It is a good sign that Xtandi is starting to work. Take care.

[Hidden in reply to spw1]

Keep us updated on how things go.

[Tall_Allen]

They can usually hit the bone twice with radiation, unless they gave 20+ Gy in a single dose the first time.

Potentia trial locations and emails in the UK are listed here:

clinicaltrials.gov/ct2/show...

I would be careful about two PSMA-based therapies on top of each other. There is a tumor-load effect, which means that if there are inadequate targets, toxicity (kidneys, salivary) can increase markedly.

[spw1 in reply to Tall_Allen]

Thank you. I am hoping that they give Lu177 if there is not too much discordance with non-PSMA avid lesions.