Completed 5 doses Lu177; complications of marrow damage and renal toxicity

[TWTJr]

Recently completed 5th course LU177; PSA initially 16, now at 0.08. However, Hgb dropped from 9.7 to 7.3 after last infusion, requiring 2 units RBS transfusion. Additionally, creatinine increased from 1.2 to 2.0, indicating significant renal toxicity. Will forego last LU177 infusion. For those considering or receiving LU177, be quite aware of potential harmful effects, particularly after receiving 4 or more doses.

[Seasid]

Are you low volume PCR?

How could your Hgb drop so much?

Could you please fill out your profile with all your treatments etc.?

[TWTJr in reply to Seasid]

Oncologist believes lack of good hydration at time of last infusion, in addition to cumulative effects from prior LU177. Yes, I am low volume disease. Gleason 7, 23 years post diagnosis, have had just about any and all treatments available over the years.

[Seasid in reply to TWTJr]

According to German study lutetium is toxic in low volume setting to the kidneys. Contact Tango65 for more information over private message. I am not a doctor but Tango65 could be helpful.

ncbi.nlm.nih.gov/pmc/articl...

[Seasid in reply to Seasid]

Uptake of PSMA-ligands in normal tissues is dependent on tumor load in patients with prostate cancer

Florian C. Gaertner, Khalil Halabi, [...], and Markus Essler

ncbi.nlm.nih.gov/pmc/articl...

[Seasid in reply to Seasid]

Uptake of PSMA-ligands in normal tissues is dependent on tumor load in patients with prostate cancerFlorian C. Gaertner, Khalil Halabi, [...], and Markus Essler

Additional article information

Abstract

Radioligand therapy (RLT) with Lu-177-labeled PSMA-ligands is a new therapy option for prostate cancer. Biodistribution in normal tissues is of interest for therapy planning. We evaluated if the biodistribution of Ga-68-PSMA-11 is influenced by tumor load.

Results

In patients with high tumor load, SUVmean was reduced to 61.5% in the lacrimal glands, to 56.6% in the parotid glands, to 63.7% in the submandibular glands, to 61.3% in the sublingual glands and to 55.4% in the kidneys (p < 0.001). Further significant differences were observed for brain, mediastinum, liver, spleen and muscle. Total tracer retention was higher in patients with high tumor load (p < 0.05). SUV in lacrimal, salivary glands and kidneys correlated negatively with PSA.

Materials and Methods

135 patients were retrospectively evaluated. SUV was measured in the lacrimal and salivary glands, brain, heart, liver, spleen, kidneys, muscle and bone. SUV was correlated with visual tumor load, total tracer retention and PSA.

Conclusions

Patients with high tumor load show a significant reduction of tracer uptake in dose-limiting organs. As similar effects might occur when performing RLT using Lu-177-labeled PSMA-ligands, individual adaptations of therapy protocols based on diagnostic PSMA PET imaging before therapy might help to further increase efficacy and safety of RLT.

Keywords: PSMA, PET/CT, radionuclide therapy, prostate cancer, tumor load

[Seasid in reply to Seasid]

ncbi.nlm.nih.gov/pmc/articl...

[Poowater]

I will note this. Thank you.

[HopingForTheBest1]

I am in between dose 1 & 2, which is scheduled in less than 3 weeks from now.

Your post is very helpful. Other than the need to hydrate a lot to help kidneys, are you aware of any other preventative side effect measures that need to be considered (ie. using Biotene mouth wash for dry mouth salivary issues)?

[TWTJr in reply to HopingForTheBest1]

I was treated at Excel Diagnostics in Houston. My oncologist at Houston Methodist, which has now started treating patients with LU177, states that she is having some success in decreasing salivary effects with icing the parotids. Published studies are equivocal. Do not know the answer, but I have grade 3/4 xerostomia (dry mouth), which over the past 6 weeks is improving somewhat.

[john4803 in reply to TWTJr]

I am trying to get into the Eclipse (Lu-177-PSMA-I&T) trial at St. Louis U Medical School, & they state, as part of the protocol, To help protect your salivary glands from radiation injuries an ice pack will be placed over your salivary glands for about 30 minutes prior to receiving the study drug and for up to four hours after the injection. I watched a YouTube video, from the UK & the patient said they insert a saline solution to help flush the drug.

[TWTJr in reply to john4803]

My present oncologist, Dr. Efstathiou Methodist Hosp. Houston, says the same thing.