After Zofigo, what next?

[Tinuriel]

Posting an update. My husband just finished 6 sessions of Zofigo (Ra223), which his doctor (MO) recommended after he failed Lupron in 12/21, and then Xtandi in 11/22. He weathered it great, with only mild digestive issues and he continues to be asymptomatic.

He meets with his oncologist in two weeks and just had bloodwork which showed a significant rise in his PSA, from 17 to 27 in 6 weeks. Though that's not what we'd want to see, it's not a surprise, since Zofigo doesn't necessarily drive the PSA down. We know he is due to have a PSMA scan 12 weeks post-Zofigo completion (mid-Sept.), and we hope that shows a reduction of the mets on his bones. Chemo is a likely next step.

I've read about the Eclipse trial (Pluvicto, 177Lu-PSMA-I&T versus Hormone Therapy in Patients with Metastatic Castration-Resistant Prostate Cancer) that is available here in Orlando. It looks like he'd qualify 12 weeks post-Zofigo. Our RO expressed doubt about the availability of Pluvicto - he has patients that would like it but their clinic has been unable to get it. I would think a trial might have access - I bet some of you would know about that.

As I prepare for our discussion with his doctors, I'm curious what you folks might recommend we discuss at this juncture. I value your collective wisdom, but even more your compassion in sharing it. Thank you!

[Shams_Vjean]

Pluvicto shortage in the US is resolving, albeit gradually. If it were me in this situation I’m thinking I’d definitely want a PSMA Pet scan as soon as it’s practicable; and if it shows high concordance of PSMA avid cells then I’d chase after the Pluvicto, if it’s within your means to travel to a trial clinic that can provide it. There are some small private and commercial airplane owners/operators who provide free transportation for cancer patients. Might want to explore that if it sounds practicable for your situation.

Otherwise, if PSMA concordance is low then, I’d guess most MOs would be recommending the docetaxal at this stage. BTW, I have a B-I-L who has been battling this beast for 27 years and recently relented to getting chemo. He’s gotten good results from it thus far.

Your daily gratitude is the perfect supplement to whatever treatment protocol your husband receives!

Best wishes to you both!

[Tinuriel in reply to Shams_Vjean]

This is much appreciated - thanks! My husbands word at this point is "content". There's lots to be grateful for for where we are at the moment.

[u302000]

Tinuriel,

Sounds like from the description of your husband's journey that he would still need Chemo prior to being covered for Pluvicto. I am in a similar situation and do not want to take Chemo. I found a Clinical Trial under Dr Scott Tagawa at WeilCornell/NYPresbyterian for LU-177 PNt2002, or LU177-I&T. it is a "PK" Trial wher everyone gets the drug and they are investigating how fast it clears the body after treatment. It may be part of SPLASH trial.

He might qualify and have only 2 day trips to NYC and one week trip with overnight provided. The rest of the trial beign 3 treatments and 2 week interval checkups provided at a more local site if that site is not taking new patients themselves. In my case that is Myrtle Beach SC. You sound like like you found one in Orlando.

Hope this may help/

Cheers,

Buddy

[Tinuriel in reply to u302000]

We'll look into the NY option - thanks!