I have now heard from Michael Hoffman at Peter Mac and his response to my request to be considered was as follows:
"Our Lu-177 treatment guidelines require that patients have previously received a taxane chemotherapy (e.g. docetaxel) as per international guidelines.
We appreciate that some patients are medically unsuitable to receive chemotherapy. Our local guidelines specify that we can waive requirement for chemotherapy if any of these are present:
High risk of significant chemotherapy toxicity by Cancer Aging Research Group (CARG) toxicity score ≥ 10
Hepatic impairment with alanine aminotransferase (ALT)/aspartate aminotransferase (AST) > 3x Upper Limits of Normal (ULN) and/or bilirubin > 1.5x ULN
Persistent peripheral neuropathy ≥ G2 Common Terminology Criteria for Adverse Events (CTCAE) v5.0
Highly frail (score ≤ 10) by Geriatic 8 (G8) health status screening tool
Eastern Cooperative Oncology Group (ECOG) performance status 2 for reasons other than cancer"
So, I thought you might want to know that it doesn't seem likely that they would consider treating any patients with Lu-177, who hadn't already received Taxane Chemo.
For the life of me, I don't see why paying patients can't choose to have the sequence of treatments of their choice (it's like being told that you can't order a main course in a restaurant until you've had a prescribed starter!) But there it is.
I'll see what clinical trials might be open to me after my John De Bono consultation next week, and keep you all posted.
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CrocodileShoes
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Here in the US the availability of LU-177 (aka Pluvicto by Novartis) has recently improved dramatically as a result of a newly opened additional production facility in NJ. Another location in Indiana is about to be opened shortly.
I believe there may be a clinical trial using Pluvicto without chemo needed in advance.
Disappointing response from PM. I'd be interested if the SAN, where my husband's MO is based, follow those guidelines. He hasn't had chemo, and as I've mentioned in a response to your prior post, he was told Lu177 is next...albeit at a cost of about $AU12 000 a session.
Were you able to check with MateoBeach (Paul) about the medical facility he accessed in Perth?
Thought you might be interested in this trial if you haven't already come across this video about the ECLIPSE from UroToday...
John, that's a very interesting trial and maybe one step closer to establishing that Lutetium earlier rather than later is more effective. It's great that you've been prepared to enrol and I hope the outcome is excellent for you.
I had Lu-177 as a first line treatment combined with ADT by travelling to Finland from the UK.
They preferred to do 3 x Lu-177 initially and then followed up with 3 x Docetaxel.
They take a stance that as there is no cure for stage 4 prostate cancer. ( I had distant bone mets) use of an experimental treatment such as Lu-177 Early makes sense. Especially as it had been extensively tested in later stage subjects.
A commute to Helsinki from the UK was very do-able. I have had so much treatment I don’t know what did what but no regret trying.
Finland and Germany were comparable but I preferred Finland as the Docrates consult holistically and plan all treatments. Germany was just Lu-177b with no wider planning offered or up front consultation.
Genesis in UK/ Onco who does it at Wellington would not treat meet as HS. My own RO from UHCL said 'not in my gift'.
If that was for me my PSA drops are recorded in my bio plus my 26.4.2022 PET/CT examination with F-18-PSMA-1007 from the top of the skull to the mid thighs are in there too.
I added in 20 x VMAT sessions to prostate as it was still expressing PSMA, I added a SBRT to T as much reduced but still flashing. Controversially Finland like to add 2 x brachytherapys which I did too.
I also added Apalutamide
After 7 months of 'through te kitchen sink' treatment I was PSA undetectable and NED on all scans. This made me eligible for the OVM 200 vaccine trial in the UK which I did in Dec 22.
I am now 12 months undetectable and NED but appreciate that ABT plus Apalutamide could have had the same effect.
My oncos are both happy for me to move to Apalutamide monotherapy from Sept and stop ADT if I want. Last ADT injection was July 23.
26.4.2022 PET/CT examination with F-18-PSMA-1007 from the top of the skull to the mid thighs, inj dose 269 MBq, imaging started 60 min pi. Comparison with NaF-PET/CT 4/22 and 11/21, F-18- PSMA-PET/CT 11/21 and Ga-68-PSMA-PET/CT 10/21.
No abnormal uptakes are noted in the brain parenchyma. There are a few mild lymph node uptakes in the neck probably reactive. No abnormal lymph node uptakes are noted in the mediastinum and axillaries. No abnormal uptakes are noted in the lungs, neither pleural effusion.
No abnormal metastatic uptakes are noted in the liver, spleen, pancreas, adrenal glands and kidneys. No clear abnormal lymph node uptakes are noted in the abdomen, pelvis and inguinal areas. Abnormal uptakes are noted in the prostate decreased in size and activity compared to the previous PSMA-PET/CT examination 11/21 (SUVmax 18.3, previously 30.3).
Compared to the previous PSMA-PET/CT examination 11/21: marginal diffuse uptake is noted in a lower cervical vertebra and tiny marginal in the III vertebra-rib area on the left, no clear uptake is noted in the rest cervical and upper thoracic vertebrae area; faint uptake is noted in the II rib, no clear focal uptake is noted in the rest ribs or left scapula; faint diffuse uptake (if any) noted in the Th9 (SUVmax 1.5, previously 26.1), tiny marginal uptake is noted in the L4 (SUVmax 2.5, previously 15.6), no clear uptake in the L1; faint uptake remains in the right iliac bone, no clear uptake noticed in the rest pelvic bones, a tiny uncertain marginal uptake is seen in the left iliac bone close to the SI- joint. No clear new skeletal metastatic lesion is recognized.
Impression: The PSMA-activity in prostate decreased in size and intensity; very good skeletal response with only marginal to faint PSMA-activity remaining in only a few lesions.
As a result of post Lu-177 and 3 Docetaxel bombs scan showing:
Abnormal uptakes are noted in the prostate decreased in size and activity compared to the previous PSMA-PET/CT examination 11/21 (SUVmax 18.3, previously 30.3).
I had the radiotherapy double here (VMAT and brachitherapy)
Plus
faint diffuse uptake (if any) noted in the Th9 (SUVmax 1.5, previously 26.1), tiny marginal uptake is noted in the L4 (SUVmax 2.5, previously 15.6)
Led to the SBRT on T9 and L4 (all at same time as my VMAT month)
I am getting a baseline PSMA PET scan next week expecting nothing as undetectible PSA and NED on other scans but wouldn't consider rejrcting my Sept ADT injection without confirmation of a clear PSMA PET scan.
There is no reason to think that prior chemotherapy makes Lu177 treatments like Pluvicto any more effective. Many other centers do not require this. Try consulting with GenesisCare (Theranostics AU) in Sydney and in Perth.
I had two infusions of LU-177 with them & was told I could not have a third unless I had chemo first then come back & try again. Was a waste of money & it only took two years & PSA was up to 19 again.
The two infusions I had made PSA go down to 1.6, what if I had a third???
Per Dr. Kwon, see video, at least a 50% reduction in PSA after 2 treatments seem to indicate a good response. youtube.com/watch?v=bwUJJP6... at about 26 minutes.
PSMA & Lutetium-177 in 2022 | Eugene Kwon, MD | DIY Combat Manual for Beating Prostate Cancer Part 4
I have always felt like many of the medical industries "rules" regarding prostate cancer are just ridiculous. One of my favorites is the rule that tumors 1 inch below the aortic bifurcation are "non-metastatic", but tumors 1 inch above the bifurcation are "metastatic". This caused me lots of problems years ago trying to get Xtandi approved. The medical establishment didnt consider me metastatic enough !
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