Pluvicto rechallenge failed

[CJ4J]

Husband successfully had Lut-177 in 2019 with the vision trial. This June he was fortunately allowed to repeat this treatment, now called Pluvicto. He had all PSMA tumors and the scan showed high expression. By the 2nd treatment the PSA dropped from 15 to 7. We were very happy and post scans showed great uptake. But by the 3rd treatment PSA hadn't changed and by the 4th it started to go back up. Choline petscan was then ordered and they found some mets worsening and now new non PSMA mets were discovered.

Why didn't it work this time? Why did the new mets become non psma? We may never know. So much to learn and research. But thankful for the opportunity to try again.

What was different this time? He wasn't on Xtandi and he started a bone enhancer over a year agovcalled Xgeva. Could this have made a difference, more research and time will help the next guy some day. Still thankful for the bonus years the 1st round gave my husband.

Not without hope though. His Dr repeated the Guardant test many times and in June it came back with High Tumor mutation. This opened up the qualification for immunotherapy. So, he will start Keytruda on Monday.

Carry on my friends in the fight!!!

CJ

[Tall_Allen]

Sadly, that's what cancer does - it mutates and becomes resistant to therapies.

Good luck with Keytruda.

[Yank66]

Please keep us updated on how the Keytruda goes. DH begins Pluvicto on December 21. Hoping for as good a response as your husband had. So glad you still have options. Wishing you the best. Even with your problems, you’ve spread some hope tonight. Thank you.

[GP24]

If your husband took Xtandi in the Vision trial but not when rechallenged, this could be the reason why the rechallenge did not work well:

publikationen.sulb.uni-saar...

pubmed.ncbi.nlm.nih.gov/319...

[CJ4J in reply to GP24]

Possibly, thanks for the studies.

But, what if it was the Xtandi working alone and not Lut-177 when he had it the first time? Still so much to learn and prove.

Note he did have great response and uptake on the 1st 2 Pluvicto treatments. But, when it mutated, they became non PSMA tumors and the Pluvicto wouldn't have worked on them.

[GP24 in reply to CJ4J]

You get a PSMA PET/CT before the Pluvicto therapy. If this does not show PSMA positive cancer, they will not start with Pluvicto.

[CJ4J in reply to GP24]

PSMA Pet/CT scans done before Pluvicto and compared to Choline pet scan showed all PSMA Mets. After 3rd Pluvicto, new Mets mutated into Non PSMA.

[GP24 in reply to CJ4J]

Your husband did not respond to Pluvicto. However, there are a few PSMA negative patients who respond to Pluvicto. Here is a case of a patient with PSMA negative mets. Since the doctors saw no alternatives any more they treated him with Lu177. He had a great response. The remaining met in the red circle was treated with EBRT after the Lu177 therapy. He is in remission for a year now.

Case study of a patient with PSMA negative mets responding to Lu177 therapy.

[CJ4J in reply to GP24]

Interesting, and encouraging for others, Thank you. So much to learn and may the next guys have more tools to be successful in the fight.

[TeleGuy in reply to GP24]

GP, is this in a paper you can share a reference to?

[GP24 in reply to TeleGuy]

This is a screenshot of a slide presented at a nuclear medicine conference. This shows an interesting exception. Following that the speaker presented his study showing that mets with missing or low PSMA expression result in a poor prognosis. In particular when there are liver mets.

publikationen.sulb.uni-saar...

[MateoBeach]

It is not for the lack of enzalutamide. Pluvicto only targets The PSMA avid cancer. Now non-PSMA metastasis have thrived. So nothing more to be gained with it. Good luck with the Keytruda. Nice to have the plans B, C etc to keep up the fight. We always have to change things up with this wiley disease.

[CJ4J in reply to MateoBeach]

You're absolutely correct. Thankful for new developments and a new options that weren't available 7 months ago for my husband.

[lokibear0803]

There are targets beyond PSMA, such that PSMA-neg can be treated (in theory). Here’s an article discussing both the copper-based imaging and targeting agents, which target the gastrin-releasing peptide receptor (GRPr):

urologytimes.com/view/fda-a...

…and here are trials using these things:

clinicaltrials.gov/ct2/show...

clinicaltrials.gov/ct2/show...

Here’s one trial using AMG-509 that I believe targets STEAP1:

clinicaltrials.gov/ct2/show...

There are probably various other trials (and other targets!) — you should do a search if interested.

Best of luck to you.

[CJ4J in reply to lokibear0803]

Thank you lokibear0803, this was mentioned by Dr. Nordquists nurse about a year ago when my husband got follow up calls from the Vision trial. Glad to see it's come to the trial stage. My husband blood counts won't qualify at this time. So, hopefully Keytruda will give him some healing and this could be another card to play later.

[Jeff3181]

Do you have insurance that approved the Keytruda? My doctor is wanting to give it to me but insurance will not approve. Suggestions?

[CJ4J in reply to Jeff3181]

Yes Jeff, insurance preauthorised it due to high tumor burden found on the guardant test. This qualified him and he is on medicare.