Lu-177 as SOC vs Clinical Trial

[MechD]

Many thanks to all contributors!

Since I've now just had my 16th cabazitazel/carboplatin chemo treatment, we're looking at options and working on Lu-177.

I'm curious that, since Lu-177 is now FDA approved and is Standard Of Care, is there an advantage to seeking a clinical trial vs receiving it as SOC? I expect the answer comes down to $s and availability/schedule.

PSA: see my profile

Thanks

[Tall_Allen]

Which trial are you considering?

[MechD in reply to Tall_Allen]

I haven’t looked yet since my MO said it’s available as SOC at UCSF and UC Davis Cancer Center.

[tango65]

This is a list of the trials, some of them are being done in California:

clinicaltrials.gov/ct2/resu...

There is a clinical trial combining Ac 225 with Lu 177 PSMA.

[MechD in reply to tango65]

Thanks I’ll check it out.

[swwags]

I will say only what I know. I was at the Mayo this week and they once again talked to me about LU-177. The nurse confirmed that the results they (Mayo) are seeing to date are much in line with the VISION trial whereas it's showing effectiveness in about 38% (I'm paraphrasing, not quoting).

Once Dr. Kwon reviewed my C-11 Choline scan and my recent marrow biopsy results, he was hesitant and said he couldn't differentiate some of the results being PCA vs. my plasma cytoma or whether I was developing multiple myeloma and referred me back to my oncologist for a PSMA gallium68 Pet scan. He offered to order one but said I would chase one closer to home.

For those that aren't aware, C-11 Choline scans "can" at times detect other cancers but cannot differentiate cancer types. PSMA is better suited in my case.

I will reach out to my oncologist in town for the PSMA post holidays. So it remains an option to me if indeed the PSMA test is positive for PSA. No help to the OP, just information for all.

[MechD in reply to swwags]

Thanks for all the great info. I must say the 38% effectiveness is disappointing.

[swwags in reply to MechD]

perhaps, but perhaps apples and oranges. I hesitate to make comments like I did because I have no medical background and I would love to read from those who have success with this treatment. If I recall, the VISION Trial showed improvement in OS AND around 38% in decreased risk of death when combined with best standard of care practices?

Her statement was perhaps more likely confirming initial improvement as determined by dramatically lowering PSA as that was her reference point. It hasn't been the SOC long enough to determine overall survival in practice so my comments are an interpretation only. (take them with a grain of salt)

[tango65 in reply to MechD]

Lu 177 PSMA treatment like any other treatment has its indications. I believe that If patients have cancers with low PSMA expression and or discordant PSMA positive /PSMA negative cancer or a diffuse infiltration of the bone marrow, they should not be treated with Lu 177 PSMA.

In the TheraP RCT patients were selected with PSMA PET/CTs and FDG PET/CTs. The results were much better than 38% and even showed a better efficacy for Lu 177 PSMA treatment when compared with cabazitaxel treatment.

thelancet.com/journals/lanc...

[MechD in reply to tango65]

We are waiting for insurance approval for the PSMA PET scan. So we’re looking for a high PSMA expression to determine if Lu-177 is indicated?

[tango65 in reply to MechD]

I would discuss having a FDG PET/CT to see if there are met which do not express PSMA.

[MechD in reply to tango65]

Will do, thanks

[MechD in reply to MechD]

What are the benefits to a clinical trial over SOC?

[swwags in reply to MechD]

I can't say with certainty but would expect clinical trials now are moving past standalone LU-177 as in the link Tango65 provided, where they attempt to combine one or more therapies eg. ac225. To early to say if it is of benefit, hence the trial.

[MechD in reply to swwags]

The trial with Abemaciclib Before 177Lu-PSMA-617 at UCSF is worth looking into.

[swwags in reply to tango65]

I have the PSMA Pylarify schooled for Wednesday 12/28/22 and should know the results by Friday 12/30/22. I know I'm an outlier here as the cancer in my marrow is Plasmacytoma so I don't know if I will ultimately be a good candidate. Mayo is certainly pushing it but I have no way of knowing if I'm truly a good candidate. I will report back what I know and ask for input then. Oncologist has me on Erleada. Kwon wants to do Pluvicto but as noted above, wants a PSMA first. Apologies if I hijacked the thread.