My sweet dad had two Pluvicto infusions (the second one was 3/3, so we’re a month out—he got a reduced dosage because his blood counts were already dropping after first infusion) and his blood counts have taken a huge hit. Hemoglobin got down to 6.3, but went up to 7.9 after two bags of blood. Unfortunately a week later he was back down to 6.6, and got another bag last night. We are trying to figure out if it’s solely the doing of Pluvicto, or just the cumulative effect of five years of PCa treatments or what. He’s also got Afib and stents so that makes the low counts even scarier. Does anyone have any information or personal experiences about how long it takes to recover from bone marrow damage post treatment, or how long it takes to get Pluvicto “out of the system” so to speak?
Thanks so much,
Nettie
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everyone reacts and recovers differently to these drugs mine dropped to high 6s then rebounded before each cycle to low 8s. But i had to stop after 3 treatments because of progression and it caused really severe bone pain right after 3 rd round.
I'm glad to hear your father is likely discontinuing the Pluvicto. Unfortunately, one possible answer to the question of when blood counts will fully recover is "never."
As TA mentioned, the anemia may not just be from the Pluvicto itself but could be from PC in the bone marrow (or both). I would ask your team if that seems to be the case with your father. (CT and bone scans will not show this, but MRI will.)
Over the course of four Pluvicto infusions, my counts were in slow decline though not alarmingly so. But after the fifth one, I went from "mildly anemic" to "moderately anemic" and my fatigue increased. I declined to get the sixth infusion, as I was also seeing rising PSA and ALP.
Within two months, my red counts fell off a cliff. Platelets, too. So for the past three months I have needed transfusions every two weeks or so. Some of this drop in counts could be attributed directly to the Pluvicto itself, and some indirectly to the Pluvicto as its failure may have helped promote micro-mets to the bone marrow. (MRI confirmed bone marrow involvement.)
I finally start BAT (high-dose T) this week after several delays due to other health issues. This therapy is a long shot so far as controlling cancer progression, but I am hoping at the least it will help with the anemia. As I'm sure you know, many therapies have anemia as a potential side effect, so I am avoiding those for now.
I cannot advise on the next step for your father, but I do advise stopping Pluvicto for sure. Good luck!
He may have a diffuse bone marrow infiltration by the cancer.
In this situations pluvicto may not be indicated since it could make things worst attacking the cancer cells in the bone marrow and the same time irradiating normal blood cells around the cancer cells.
It is a difficult situation since problems with the CBC may disqualify for clinical trials and other treatment such chemo will also affect the bone marrow.
I followed Lu177 after each infusion with a Geiger counter and did 5 infusions. Unfortunately CT and MRI is showing progression after 5 infusions at CT/ C3 and C4. My T spine maybe diminished in activity but my prostate showing progression by increased size of tumour. It’s obviously the CSpine that’s the worry as further growth could be disastrous.
I followed exit of Lu177 with a Geiger counter and took around 4 days to be really low at 3 feet distance but still showing some CPM counts per minute after 3 weeks when Geiger placed directly against my liver/ kidney/ bladder where the Lu177 exits the body.
My husband is in the same situation here. Last Pluvicto was in November. Has had 3 blood transfusions in January-February. What helped was 2 Iron infusions in February and now Hemoglobin is steady in the 7's. But his Platelets continue to drop and currently at 18. Petscan confirmed infiltration of cancer in the bone marrow. The next treatment after Pluvicto was Keytruda, but that failed too. Went on dexamethasone for a bit to help stop his decline and get his appetite back and stop nausea. The only option left for care is Nubeqa and just got approved to start last week.
Did he have gene mutations identified in order to try the Keytruda? My dad has ATM mutation and tried Lynparza previously but it wasn't effective. We might get him genetic tested again to see if any other mutations will show up. My dad hasn't done Nubeqa either--did your husband have Xtandi or Zytiga previously?
Yes, he had High Tumor Burden which qualified him for Keytruda and also a small ATM. But blood counts are to low for anything else.He has taken Xtandi, Zytiga and Erleada. Nebeqa was the only one left to try, and it took a little work to get it approved.
Really tough if PC has infiltrated bone marrow to such a high degree that blood counts are not replenished. Are platelets and WBCs similarly low? Thinking that perhaps an EPO drug (erythropoietin) could stimulate remaining potential for RBCs. And Nulasta for WBCs. Testosterone also stimulates marrow production but BAT not appropriate if painful bone mets or critical spinal mets present. Then transfusions and stay close to him.
Platelets are at 80 but were at 70 a few days ago and WBC also low. Yeah, I think there's too much cancer activity for BAT. He had another transfusion yesterday. He's also holding his blood thinners and that is causing hemoglobin to rise a bit which is a good sign. Apparently extended use of blood thinners can cause anemia...
Sorry to hear that Pluvicto wasn’t beneficial. Tough spot to be in for sure. For my guy, the counts never recovered. Platelets soon took a tank as well. Hoping your dad’s drops are just transient. Best wishes to you. Your dad is lucky to have you. Prayers!
Thank you! He's been holding his blood thinners and we are seeing a rise in his numbers, so I'm hopeful we're on the right track. I think Pluvicto pushed him over the edge.
We are now in a waiting line for Pluvicto. He's gone through the whole SOC regime starting in January 2018. He had 34 tri-weekly rounds of Jevtana. (Almost 2 years.) PSA holding in mid-30's. PSMA scans show no major spread past initial results after 1st chemotherapy in 2018. Doctor says "remarkable" response to Jevtana.
So they took him off it to start Pluvicto. Major withdrawal symptoms from Prednisone.
After reading these threads.. I'm wondering, is it worth it?
I know he's exhausted after this 2 year routine.. like having the flu for 10 days out of every 21. He says he's ready for something new and promising.
Now I'm doubting that decision. 😕 especially since we have to wait at least 2 months sans treatment until a shipment arrives.
My question: Was it worth it to you and your hubby? Was he able to have a very good quality of life? Were there other side effects that made the decision to receive Pluvicto a regretful one?
Sorry for making this about us... but my heart hurts a little with all this!
Hi there--unfortunately Pluvicto was not effective for my dad and his cancer-related pain is just increasing so I would say no, not worth it for us, but upon looking back at his PSMA-PET scan, it did say he had low to medium expression of PSMA, which could be the reason why he's not responding well to it. Some men respond very well, others don't. I would encourage your husband to get both a PSMA PET scan as well as FDG PET scan, and that might give a clearer picture if Pluvicto will be effective.
To be honest, my dad's quality of life is quite low right now. He's in pain, sedentary, and not able to do things he previously loved. It is worth it to me and my family to keep him with us as long as possible. He has lots of grandbabies he wants to see grow up as long as possible.
I’m sad to say my dad passed on August 30th. He was essentially blood transfusion dependent from April and his last transfusion was 6 days before he passed. They most definitely helped his energy for a while but the last month they did very little to improve his quality of life. Dad wound up having one full and one partial dose of Pluvicto at the beginning of this year but really no effective treatment from October ‘22.
I’m sending you and your dad many good wishes. Please let me know if there’s anything else I can answer.
Oh no. I am so so sorry. I was worried this was the case 😢 my dad became castrate resistant last year. We stopped xtandi when it failed a few months ago and did some targeted radiation. He’s starting chemo next week and I’m praying for good results and an improved quality of life when it’s all done. I know pluvicto will be in his future (hopefully not the near future), so I was wondering your dad’s results. I feel terrible to have read that he passed. 💔 thank you for responding. Wishing you the best on your healing journey —Michele
Is this your dad's first time with chemo? My dad was diagnosed in March '17 and immediately started Docetaxel which was definitely a success. He tolerated it pretty well except for the pain from Neulasta which we learned could be tempered by taking Claritin in advance.
Thank you for your good wishes. My dad had nearly 5.5 years after his initial diagnosis, and got to see the birth of 2 additional grandchildren. We are grateful we didn't lose him in October 2020 when he had a bad bout of Covid. The loss is profound, but it was a blessing to have time with him these last few months, as hard as it got in the final weeks.
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