the more I read, the more I have a feeling, that chances of great response to Pluvicto / LU-177 are rather slim after being on ADT for years. It certainly seems the case for castration-sensitive PC, not sure about castration-resistant PC.
Continuous long-term ADT significantly reduces the visibility of castration-sensitive PC on PSMA PET/CT. If the objective is visualization of the maximum possible extent of disease, we recommend referring patients for PSMA PET/CT before starting ADT.
Perhaps it would be helpful if we could gather in one thread experience of members, who had Pluvicto / LU-177 treatment or combo LU-177 & AC 225. Stating if they were castrate-sensitive or resistant, how long they had been on ADT, were they still on ADT when taking PSMA pet scan and treatment and how effective the treatment was. I know we are all individuals, but perhaps we could see a pattern.
Thank you to all, who will contribute / share their experience.
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MyDad76
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I'm not an expert by any means, but I think you are mixing up two things that, while related, are very different. As I understand it, the problem with PSMA PET scans after ADT is that ADT tends to shrink the PCa tumors, often to such an extent that it is difficult to see them on the PET scan. Bear in mind, this is a limitation of the human eye (of radiologists reading the scan) to see very small, possibly even microscopic, tumors. On the other hand, Pluvicto is seeking out PSMA-expressing PCa cells, and I would assume has no such limitations to its "sight." At least that's my understanding, but I'm sure someone will correct me if I'm off base.
Honestly not sure. My understanding, which could of course be incorrect is, that ADT influences PSMA expression. And that while short term ADT increases PSMA expression, long term ADT acts the opposite. And that Pluvicto only works with cells that are PSMA-expressing.
I think, but don't know for certain (perhaps TA can weigh in) but the VISION Trial prolly has the most complete data and I believe the overall survival rate noted was 15 months vs 11 months.
I've found that insurance will almost always cover FDG. 225AcPSMA617 can be very toxic, especially if the tumor load is low -- I'm hopeful that the J591 ligand that Scott Tagawa is testing may be less toxic.
My brother has been on ADT since 2007 and has had a strong response to his first two doses of Pluvicto. His PSA has gone from 205 to 1.35. Scan is scheduled next week.
My husband had been on ADT for 16 months when he started Pluvicto but had a poor response due to his overwhelming cancer load. He had been on ADT for 21 months when he received Ac-225, which was also ineffective. He was highly PSMA avid; but the volume was just too great.
Perhaps there is a sweet spot where these radioligands work best. If the PSMA avid cancer volume is too low, there are more side effects, but if it is too high, it’s simply not enough. Perhaps some day the dosing and frequency will be able to be tweaked or individualized. My husband did demonstrate response in many areas, and his doctors wondered if he could have had a shorter interval between doses, perhaps the Lu-177 could have stayed ahead of the aggressive cancer. Obviously there is currently no guidance for altering the frequency.
In spite of Lu-177 not being “enough” to stem the tide, he had a tremendous clinical response to Pluvicto, feeling better within hours of receiving it.
Thank you very much for sharing, most interesting experience. It is still early days, but I hope in time they will be able to determine who is most likely to have dramatic response.
I'm been dancing with this friend of mine for 16 years. Last year I was accepted into a trial at Dana Farber for LuPSMA177. My PSA was 8.0 at the time. One met on spine and one in groin. I completed all 6 infusions. Fairly well tolerated. Fatigue being the most noticeable. Initial response was fantastic. PSA dropped to 0.19. But was not durable and slowly increased. I am Chemo naive. Was on Lupron and Zytiga for about 18 months prior to trial with PSA doubling every 3 months. Presently on a self administered BAT protocol. Responding well into my 3rd cycle. QOL much improved as well. Exercise is extremely important to consider into your therapy. I row for a hour each morning, the last 15 minutes at the Max level.
Thank you so much for sharing. In Slovenia there is unfortunately no one who will support us with BAT protocol. You should not even mention it... I wish you continues success in living with PC.
I just had my first lutetium infusion 2 days ago on PSMaddition trial. Low burden metastatic. On ADT for 3 months and PSA went down to 0.16. Still PSMA avid as of a few weeks ago, though the expression was low (SUV 4.1 for one spot and 1.1 for another), this was enough for acceptance into trial (would have been nice to have infusion earlier, but admin delays). No side affects, other than a bit of dry mouth. Had a ravenous need for protein the first morning after the injection, but maybe because of 2 blood draws before infusion.
Hello everyone and new victories! I think the mistake lies in the very formulation of the question.. In the studies cited by the author of this publication, we are talking about the use of ADT in prostate cancer sensitive to castration.
Pluvicto / LU-177 is approved for use based on VISION studies, where volunteers were selected exclusively with prostate cancer resistant to castration and who passed all standard treatment regimens!
I have been on continuous ADT (Zoladex 3.6/45 days) since 2016 to the present. In June 2021, I completed the 4th course of combined PSMA therapy using simultaneously two isotopes of Actinium and Lutetium in half doses (4GBq + 4MBq). My prostate cancer has already been resistant to castration since January 2020, but nevertheless my radiologist strongly recommended taking ADT during therapy and at least two years after it ends. Today it has been two years since I completed PSMA therapy and my PSA has been falling all this time, today it is 0.015 ng/ml, before therapy it was 213 ng/ml with total lesions in the bones of the skeleton.. Three days ago I passed two PET tests with PSMA and FDG.. The bones are clean, there is no primary focus in the prostate! I will share my results in more detail in a separate publication. You can read about my experience of undergoing combined PSMA therapy on my page.
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