Failed Docetaxel, just like everything else.

[bglendi53]

So my MO took me off the Docetaxel after 4 sessions. PSA rose from 120 before the first session to over 300 just before session 4. Scans showed substantial expansion of cancer including lymph nodes as of 1-20. That's a documentary all by itself.

Now MO wants to put me on Xtandi and will eventually ( 3-4 months ) start me on Plutvicto once approved. Since becoming mCRPC, I have failed Xofigo, Zytiga, and now Docetaxel, all in the past9 months.

Does anyone else have a similar story, and is there any real hope for Pluvicto working any better.

[Tall_Allen]

Pluvicto was found to extend life in exactly those circumstances.

[bglendi53 in reply to Tall_Allen]

Thanks TA, might finally be some good news. Do you think I will continue on Xtandi while going through the Pluvicto treatments?

[Tall_Allen in reply to bglendi53]

I think that at first Xtandi will increase PSMA expression, which would help Pluvicto work better, but with continued use, it will decrease PSMA expression, so timing is everything. There is an Australian trial now that combines them:

clinicaltrials.gov/ct2/show...

I would also advocate for an FDG PET scan, but I know it is controversial.

[bglendi53 in reply to Tall_Allen]

Good information, thank you.

[CAMPSOUPS in reply to Tall_Allen]

That's interesting that FDG-PET is controversial. I thought knowledge of possible discordance was widespread and use of FDG-PET was well advised.

[Tall_Allen in reply to CAMPSOUPS]

Australia (led by Michael Hofman) has championed the "discordance"prohibition, but FDG PET was not required in the VISION trial that led to approval by the FDA. To "steel man" their arguments, they argue that the survival increase in VISION was irrespective of discordance, and only required PSMA avidity. Only about a third derived no benefit, and only about 10% seemed to get markedly worse. They aren't convinced by the tiny (n=30) Australian trial.

euoncology.europeanurology....

So it is not SOC to get an FDG PET along with a PSMA PET before Pluvicto. IMO, it's prudent, but it is just my opinion.

[Keeper70]

Geez Bill, don’t give up, Nvr give up, Pluvicto will work for you! I know it sucks when things stop working, hoping and praying for you on next steps🙏

[bglendi53 in reply to Keeper70]

Thank you so much, I'll hang in there.

[spw1]

My husband had v little time out of each treatment incl Enzalutamide (5.5 months before resistance although we continued it for a few months on MO's recommendation until chemo began). Chemo did not work at all (Docetaxel 4 infusions and Cabazitaxel 2). Lu177 was attempted but advised against due to discordance with FDG (lot more FDG avid lesions than PSMA avid) and bone marrow involvement. Currently trying Abiraterone. I think it helped him a bit but I cannot say that he is thriving on it. Good luck with Lu177.

[Yank66]

Hoping to add some encouragement here. DH has seen a PSA drop of about 30% (from 193.8 to 137) after first Pluvicto treatment in December. He took Xtandi for about a year, then Lynparza for about a year, then 5 cycles of Doxetaxal which the MO stopped because of risking PSA and neuropathy after 2 falls. The doctor administering the Pluvicto advised us that PSA can fluctuate and not tell the whole story about Pluvicto’s effectiveness. But we are hopeful and that is so important.