Are there options past Pluvicto?

[Marit85]

Hi!

First, thanks to all of you for sharing and caring for each other in this forum. It means so much, to so many of us! I am on this forum on behalf of my father. He was diagnosed last year, and over the last 15 months he has endured ADT, Zytiga, Docetaxel (6 cycles), Cabazitaxel (four cycles before it failed), and now Xtandi and Pluvicto (and a bone strenghtener). I have added a more detailed medical history in my bio. After the first Pluvicto infusion his PSA went from 49 to 27, at two weeks post infusion. However, a couple of weeks later, when he had his second infusion, it had risen again, to 42. So PSA-wise, it seems he had only incremental results from the first infusion. Even though his bloodwork is still good he now experiences fatigue and aches that comes and goes. Considering his history of failing all treatments pretty fast, we are preparing for Pluvicto also failing. Despite having endured so many treatments over only 15 months, his health is ok. He is walking a couple of miles a day, and trying to live life as normally as possible. Of course his hope, and our hope, is to keep him around for as long as we possibly can. Yet it seems we have run through pretty much all SOC treatments in such a hurry that now there is really nothing much left. He did a liquid biopsy in january, that showed nothing but a TP 53 mutation. He is also symptomatic and has had some bone pain, so BAT is not on the table.

Is there anything out there we may pursue? I read some studies on AC-225, but from what I understand the results seem to be very limited with patients that has already failed Pluvicto? We live in Scandinavia. Thanks again to all of you for being part of this community!

[Tall_Allen]

Xofigo and combinations:

prostatecancer.news/2021/02...

[Marit85 in reply to Tall_Allen]

Thank you! I guess we will have to see what the scans say after the third infusion of Pluvicto. Xofigo has been discussed before, but because so many lymph nodes are involved, it has not been considered our best option. But maybe in some kind of combination it will be a something our MO can support!

[Nigel2023]

I am also looking at Actinium 223 in Heidelberg. I have heard of good results from Prostate Oncology Specialists, Marina Del Ray, even following Pluvicto. After 6 Pluvicto infusions ar Fred Hutch Seattle, my PSA is down to 10.00. I will either go for more Pluvicto or switch to Actinium by going through Mayo Clinic, MN to Heidelberg, Germany. Dry mouth is said to be much more severe with Actinium. I have tolerable dry mouth now.

[Marit85 in reply to Nigel2023]

Thank you so much for the reply! How has your response been to pluvicto? My father is pretty worn out by it. The fatigue is rough.

[HopingForTheBest1]

I found a recent post from member Biobro titled "Where to go after LU-177?". Found it helpful.

[Hidden]

You have the option of Pembrolizumumab

[Marit85 in reply to Hidden]

Hi! Thanks! Wouldn’t he need to have the right gene mutation for that to work?

[Hidden]

It seems to work bettter with BRCA2 and ATM, but previous treatment with Enza is good as a primer, upregulating PS-L1. Also use of the PARPi is helpful, once again upregulating PD-L1. Use of BAT is also on the positive side, but you have to be asymptomatic for using it.

[ishitasen]

Yes Ac-225 is still a option for your father, usually it is given in patients who failed on Pluvicto therapy however the data as well as availability is quite limited.

You can explore for that option also.

[Marit85 in reply to ishitasen]

Thank you very much! Considering how he has completely failed Pluvicto, we suspect he may have developed non-psma avid tumors during the course of treatment. In that case I would think AC 225 is not an option? Would we have to rule that out by doing an FDG scan?

[ishitasen in reply to Marit85]

Yes Definitely, an FDG PET-CT would be of immense help...

[Pluvic123]

May I ask the age of your father? Mine is 87 and a week or two away from beginning Pluvicto. He did docetaxel summer 2023. January 2024 until Sep 3024 did cabzitaxel. Metastasis to spine and pelvis, some nodes in lung, none to organs. Tylenol at night as painful to sleep; uses a walker but often uses hands to lift leg. His red blood count has always been on low side so they say that is the most worry they will have with Pluvicto. Yet we are all worried now.