considering Pluvicto or Erleada

[GTOGuy]

I finished 2 rounds of low dose CheMo which did not help. I have one kidney so I really need to take care of it. I was in renal failure in July for a few days but back to “normal” now. I also had a mild stroke over Christmas and almost back to “normal” PSA is up to 213 so I need to decide whether to try Erleada (I failed Zytiga and Xtandi) or opt for a Pluvicto regime. There is a doctor in Orlando doing the treatment. Has anyone here with kidney issues done Pluvicto yet ? Thank you

[MateoBeach]

Pluvicto is excreted through the kidney while still emitting radiation. So it can adversely affect renal function. I believe it would not be approved unless eGFR is at least 60. You could discuss a few cycles of BAT. Testosterone is not harmful to kidneys and can restore the effectiveness of enzalutamide (and possibly also for apalutamide since it is similar acting).

[MateoBeach in reply to MateoBeach]

Watch or read the following then send/discuss with your MO.

urotoday.com/video-lectures...

[GTOGuy in reply to MateoBeach]

Thank you - I will check out the video

[Hidden in reply to MateoBeach]

thankyou

[GP24]

Usually the doctors check that you have sufficient renal function. But it has been successfully applied in patients with impaired renal function:

Slide covering impaired renal function and Lutetium therapy

[GP24 in reply to GP24]

Even patients on hemodialysis can get Lutetium therapy:

Case report of hemodialysis patient treated with Lutetium therapy.

[GTOGuy in reply to GP24]

thank you

[Tall_Allen]

Pluvicto is excreted by the kidneys but doesn't usually damage them. There are a couple of similar radiopharmaceuticals in clinical trials if you can travel for it that have lower kidney uptake and faster kidney clearance:

clinicaltrials.gov/ct2/show...

clinicaltrials.gov/ct2/show...

[tango65]

The proximal tubules of the nephrons express PSMA. Pluvicto will get attached to these cells and it will irradiate them.

en.wikipedia.org/wiki/Proxi...

There is also irradiation of the whole kidneys since Pluvicto is eliminated in the urine.

Consult with nuclear medicine if this treatment is adequate for a person with one kidney.

You could consider a clinical trials with Lu 177 and the aJ591 ligand which does not affect the kidneys

clinicaltrials.gov/ct2/resu...

[GTOGuy in reply to tango65]

Thank you

[tango65 in reply to GTOGuy]

Best of luck!!

[noahware]

One of the keys to preventing Pluvicto kidney damage (which I assume holds true whether you have one or two of them) is to eliminate radiation by urinating, which happens better if you urinate frequently and in volume. So if you go the Pluvicto route, BE SURE to be very well hydrated, starting a day or two before each infusion and continuing the day of, and the day or two after.

I believe in Germany they bring you in early to make sure you drink sufficient water beforehand. It's actually part of the treatment. In the US, it's just another thing listed in the "rule book" that they give you, so it's on you to make sure it happens!

[GTOGuy in reply to noahware]

thank you

[tango65 in reply to noahware]

In Germany they gave you the Lu 177 PSMA in a larger volume than in the USA and then they infuse 500 to 1000 ml of saline.

[ellie2211]

My dad did 6 cycles and had some kidney damage. It is worth discussing with your oncologist if psma levels look promising.

[chrisrock]

Yes you can get treated with Pluvicto despite your kidney issues.