Triplet Regimen vs Clinical Trial (Pluvicto)

[Bruce98]

I was recently diagnosed with advanced prostate cancer with diffuse bone metastases (March 20th). I met with my oncologist at Sloan Kettering on March 23rd and received my first hormone treatment (Degarelix). My PSA has already dropped from 189 to 23.89, and I had my second hormone treatment, which was a shot of Lupron, on April 18th. I had a follow up appointment with my oncologist on April 20th. During this appointment, we discussed treatment options. He said that I may be a candidate for a clinical trial, which is comparing standard doublet treatment (Lupron + anti-androgen oral therapy) to the doublet treatment plus Pluvicto. The other treatment options is a triplet regimen, which will include the Lupron + anti-androgen + chemotherapy (docetaxel). 

I am 64 and otherwise in good physical shape. I would like to treat this as aggressively as we can, but I’m not sure what is the right choice in this case. I was wondering whether anyone has opinions on the clinical trial vs. triplet treatments. My oncologist did not express any opinion and said that the choice is up to me and my family. A few specific thoughts or concerns:For the clinical trial, although there is only a 50% chance of receiving the Pluvicto, I was told that I would be moved into the treatment group if my condition worsens during the trial. I have an atonic bladder and the clinical trial requires lots of water drinking and bladder voiding post treatment.

I am wondering if anyone has opinions on the oral therapy. I was given information on apalutamide, darolutamide, enzalutamide, and abiraterone acetate. I’m not sure if I will have a choice, but I’d love to know if anyone has experience or opinions, especially if your disease has manifested similarly to mine.

[Tall_Allen]

I would have less of an opinion (i.e., equipoise) if the SOC were the triplet (which it now is). The triplet is better than the doublet with chemo and probably better than the doublet with abi or Nubeqa. Pluvicto+SOC should have been tested against the triplet at least in the control group. In other words, IMO a better test would have been Pluvicto+doublet vs triplet. Lacking that, IMO the triplet is better or at least there is more reliable info on it.

[Brysonal]

interesting. Do you have the details of the clinical trial . Is it PSMAddition? I wanted to join this trial when I was in the same place you are ( multiple bone mets) but was out of time to join in UK as it hadn’t started and I needed my degerelix injection so I travelled for 3 x early pluvicto privately. The advantage of that being able to choose to still add Docetaxel ( I followed up with 3) and then added the advanced hormone Apalutamide.

I also added a radiotherapy triple as my prostate was active and ‘stampede style’ scans showed I’d benefit to radiotherapy to the prostate non standard of care I added some brachtherapy and SBRT so am mega treated

Disadvantages were cost and risks of SE.

Good luck

[Labbab]

Sounds like my husband has been offered same trial at Cleveland Clinic. We are reaching out tmrw to get the ball rolling. No other issues besides his prostate cancer. He is 2 weeks into hormone therapy, Orgavox and Xtandi both taken orally.

[tango65]

IMHO, the important thing is to get ADT plus abiraterone which has shown, in the final results of the Stampede trial, a median overall survival of 6.6 years, longer than any triple therapy so far.To this doublet you can add chemo or pluvicto and see what happens.

urotoday.com/conference-hig...

The Therap study showed pluvicto has similar median overall survival than cabazitaxel.

ascopubs.org/doi/abs/10.120...

[Woodstock82]

My advice is to go for the path which gets you Pluvicto sooner rather than later. If it gets you good results, great. If it doesn't, or if the regimen gives you trouble, you'll know sooner and while your reserves are stronger and in better shape to adapt to a change in therapies.