I am starting my 21st year in the battle with the beast. The Lord has blessed me with long life in spite of my PC. I am just coming off 6 Zofigo treatments. Moderate fatigue, side effects, PSA - 24 , ALP - 128.
My Phoenix Mayo MO has recommended six sessions of Pluvicto. I have read here on health unlocked, that Pluvicto is a relatively new treatment that has had some success in Europe. Have any of you had Pluvicto treatments and did you have any success. What should I expect.
As always, I sincerely appreciate all of you all of your input.
Tom -- even though I just posted this reply to you in another thread, I want to repeat it here so others might see it, too.
Best, Noah
Scheduled for 6 cycles in clinical trial, but I quit after 5 sessions... PSA dropped after the first, but steadily rose thereafter. Scans showed what my MO termed "stable" disease, with some old mets showing less uptake but also new mets appearing and then growing.
Very few side effects with first four infusions: minor fatigue for a few days, and nausea that I managed to prevent in later infusions by taking ondansetron (Zofran). But on the fifth infusion the SEs were much worse, which I attribute to being dehydrated. It is VERY important to hydrate the days before, of, and after infusion -- radiation is removed via urination!
The worst SE for me was becoming more and more anemic over the months, gradually shifting from the mild anemia I had with ADT for the past two years to what would be termed "moderate" anemia. While not needing transfusions, that seemed to lead to more fatigue and shortness of breath on exertion, which remains even a few months after my last infusion. This is not a common SE, but can happen, so keep an eye on blood counts!
Lu 177 PSMA treatment has been used in Europe for more than 10 years. I had treatment in Germany in 2016. I had only 1 treatment with not complications except for some transient fatigue. I had lymph nodes mets only and one treatment made all of them PSMA negative.
The Vision trial done by Novartis showed Lu 177 PSMA effective in prolonging life and progression free survival in very advanced cancer with a multitude of previous treatments.
The Lu 177 PSMA is usually well tolerated, with some fatigue, transitory dry mouth, perhaps some nausea. More serious complications happen in patients with multiple bone metastases and diffuse infiltration of the bone marrow by the cancer. In this situation the treatment may cause bone marrow suppression.
The efficacy seems related to the PSA expression of the cancer.
In general terms if the SUVs of the mets are around 10 or they are higher than the liver it may be good response.
It also depends on the presence and volume of mets which are PSMA negative. If there are many mets which do not express PSMA then they can't be treated with Lu 177 PSMA. and the results of the treatment will be poor.
This could be studied before treatment doing a 18 F FDG PET/CT and see if there are discordant mets (some PSMA positive, some PSMA negative identified by the FDG PET/CT).
Thanks so much Tango for all your insight. I just got a PSMA scan a week or so ago. It gives some description of the PSMA expression that I really don't understand. Do you mind if I look it up and ask you some more questions???
Disease progression with new areas of osseous metastatic disease and increased tracer activity within previously visualized osseous metastases, as above.
PSMA score = 3
---------
PSMA grading scale (miPSMA)
0 = less than blood pool
1 = equal to or above blood pool and lower than liver
2 = equal to or above liver and lower than parotid gland
piflufolastat F 18 injection (PYLARIFY F-18),9.9 millicurie
The patient reports no recent vaccinations.
TECHNIQUE: Positron emission tomography of the torso skull to thigh was performed per protocol in this fasting patient. Non-contrast CT was performed for attenuation correction and anatomic
correlation. Automated, variable CT mA dose adjustment used.
The cancer has several bone metastases which have intense PSMA expression (the max SUV detected is around 21). This value is 3 times the SUV of the liver!.
It means the cancer has a high PSMA expression and one should expect a good treatment response when treated with Lu 177 PSMA 617.
PSMA is a protein which coexists part in the surface and part inside the cancer cells.
PSMA expression is a function of the amount of this protein that is showing in the surface of the cancer cells,.
Once the Lu 177 PSMA 617 is injected it will find and it will bind to this protein
The Lu 177 emits radiation (beta particles) which will eventually kill the cell and any other cells around 2 mm.
Since periodically the external part of the PSMA is introduced inside the cell (the PSMA 617 is a small molecule ligand) if the PSMA is attached to the Lu 177 in the surface it will introduce the radiation even closer to the nucleus resulting in the destruction of the cell . It usually ibreaks one strand of the DNA which will kill most the affected cells..
The lacrimal glands, the salivary glands, part of the duodenum and jejunum (small gut) and proximal tubules of the nephrons (kidneys) also express PSMA and Lu 177 PSMA will attache to these cells as well. Liver and spleen cells also express PSMA.
The clinical experience indicates that there is not major problems with the lacrimal glands, the liver and the spleen. There could be transitory problems with the salivary glands, the small gut and the kidneys,
Most of these organs seem to recover well but eventually with subsequent treatments there could be problems with the kidneys which is one of the limiting factors for therapy with Lu 177 PSMA 617.
If there is diffuse infiltration of the bone marrow by the cancer the Lu 177 PSMA 617 attached to the cancer cells in the bone marrow will also irradiate and destroy adjacent blood cells causing bone marrow failure with low WBC, platelets and hemoglobin. Some centers consider diffuse bone marrow infiltration a contra indication to use Lu 177 PSMA.
Unless you feel the need to keep this info private, I think it might be helpful to some to see it and to see tango65's response, in a new separate post. I personally have no understanding at all of what a PSMA report really means!
Haha, not my strong suit! What I usually do is just scroll over the text and copy and then paste into the post. Is the report in a format that will let you do that?
Check it out. I put it up. Tango 65 is so helpful. It is so great that we have so many caring people on this site because we're all in the same boat together. God bless all of you.Tom
My husband has had 4 Pluvicto treatments. He tolerated them well, with no discernible side effects whatsoever.
He has a very aggressive cancer, high volume skeletal mets, and right before he started Pluvicto in August his liver showed a tiny spot. All of his metastases seen on imaging (PSMA and choline) are intensely PSMA avid. After 4 treatments, while his pelvic mets have disappeared, his spine has improved, and his ribs show minimal disease, his liver is now full of metastases. It is considered a mixed response. Ironically, the two weeks preceding his last dose he was not feeling well at all. Nightly fevers, no appetite, tremendous fatigue, infrequent vomiting. He has turned right around in the 9 days since his last treatment! Feels so much better, no fevers, fatigue has lessened and appetite improved.
However, since his scans look so abysmal, this was his last treatment. He is leaving for Turkey in 2 weeks to receive Ac225. Hopefully he will be well enough to travel, as his great response to Pluvicto only seems to last 3-4 weeks and he will be pushing that envelope.
We all wonder if he could receive the Pluvicto every 4 weeks, if it would not be so overwhelmed by his huge cancer burden, but obviously we will never know as it is not indicated to be given more frequently.
We are still big fans of Pluvicto, in spite of his results. In fact, my 82 yr old brother will be receiving his first dose of Pluvicto while my husband is in Turkey.
Hi my husband was diagnosed in 2008, do read profile, had widespread avid PSMA bone mets December 2021, started Lu in March 2022, has just completed his 6th treatment of Lutetium 177, PSA started 10.4 now PSA 1.4, last PSMA PET Scan after 4th treatment showed good results but some mets still showing, advised by consultant to have further 2 treatments. SE, has become more anaemia, fatigue+, always an early up person but had to succumb to resting longer in bed, the lack of energy frustrates him, nausea occasionally, very dry mouth, difficult to chew and swallow, lack of appetite, sore eyes, but much better than chemo. Hope this gives some insight, Lu will give more time, but we will not be complacent and we will be looking for new trials that he would be eligible for. unfortunately as he has had this long journey and undergone trials & treatments that were available, eligibility is a problem for most trials available at the moment, hope this helps, our very best wishes Jan & Tony
I am not as far along as the others folks, just finished second dose. No SE’s to speak of, waiting on the most recent blood test results. My PSMA PET only indicated a couple of lymph nodes so hoping for a food outcome.
I have had 4 of 6 infusions. So far, the only side effect has been a dry mouth that worsened after each treatment, but has been transitory. While my PSA has never been that high, each treatment has shown a decrease in my PSA, which is now .4. The infusion takes about 15 minutes and I stay another hour until I am emitting an acceptable level of radioactivity. For me, the treatment so far seems to be working and the side effects are not bad.
Hello fellow PC fighter. I’m new here and am interested in any replies from those who have started taking Pluvicto or have finished. My PSA has started rising rapidly in early 2022. I heard about Pluvicto and took first treatment on Sept 15th 2022. I’ve now had 3 treatments. I was scored as very highly to benefit based on PET scans, bone biopsy and blood analysis. Now my hope is dwindling as my PSA has risen from 17 to over 71 since I started taking it. I know it works because I told a young man at my former employer about it for his father ( he has severe pain and it had metastasized to his sternum and they basically sent him home to die. Now after just 3 treatments he is cancer free and zero PSA and no sign of cancer anywhere in his body. I’m hoping to hear from anyone on this blog who has had success and or failures with Pluvicto ( number of treatments, PSA levels, any details at all are greatly appreciated!!!
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