Hurdle

[RunThru]

Finished 6 pluvicto in May. PSA started at 15 ended at 35. Bone scans at end say many Mets to bone. I particularly felt very winded towards end of pluvicto treatments. I was walking 3-5 miles until April then achiness in femur, and loss off breath. MO had me scheduled to start xofigo 3 weeks ago but hemoglobin dropped to 6.7 so transfusion instead. He now what's to rechallenge with taxotere starting tomorrow. I had hemoglobin tested two weeks ago and it was 7.5. But tested again yesterday and was at 6.9 so another transfusion. I go in for blood first and if ok, start taxotere. MO isn't sure why hemoglobin tanking. Either pluvicto or PCa.Anyone have anything similar? Any other treatments, etc? Thanks

[Spyder54]

RunThru, first, I have not yet had Pluvicto. From reading some of the guys here that have, there seems to be a delay in PSA drop. Like Beam Radiation, wait 3 months because dead and dyeing PCa cells give off lots of PSA. You may want to be patient and see if #’s drop!

Best of luck for better PSA #’s, Mike

[leebeth]

A drop in Hgb is not unusual after Pluvicto. My brother had only two treatments, the last one was March 6, and his counts are still low. He is getting one unit of packed red cells and one unit of platelets this morning.

His PSA fell from 205 to 1.15 from just the two treatments, however.

[Ramp7]

I completed 6 infusions with the trial study at Dana Farber. By the end of the treatment my Hemoglobin was also low. It did not require any intervention. Initial PSA response was excellent. 8.1 dropped to 0.19. But then slowly went up. Presently doing BAT. PSA has been stable. QOL much improved.

[SeosamhM]

Hey, RunThru. I, too, had my last Pluvicto and the end of May, and I was glad to see the back of it despite the great press on fewer side-effects (as compared to traditional chemo). I have been exhausted, achy, and my endurance is poor. Per follow-up PSMA scan, while one tumor in my femur seems to have shrunk, the new one in my scapula actually got bigger, and my spine tumors are still extremely PSMA-avid. My hemoglobin has dropped to 10 - started at 13 at the start of Pluvicto - and is continuing to drop even though "active" treatment is done (i.e., cells are no longer getting nuked by Lu177).

It seems both of us have myelosuppression - yours obviously serious.

This study came out in 2021:

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

It appears that "significant" hematotoxicity (e.g., low red blood cells, low white blood cells, low platelets) appears in less than 10% of men treated with Pluvicto. But since both of us have had prior taxotere treatment, I found this interesting:

"Previous taxane-based chemotherapy was associated with an increased incidence of significant hematotoxicity (OR: 4.62, 95%CI 1.23–17.28, p = 0.02), while treatment with 223Ra-dichloride, cumulative RLT treatment activity and activity per cycle were not significantly correlated (p = 0.93, 0.33, 0.29)."

While the study points out that the hematotoxicity is reversible, it references follow-up at 8 months!! To me, at this point, that's a lot of time! I don't think I will have the luxury.

Good luck! - Joe M.