Disease to bone

[JoeyDad]

has anyone had multi focal, metastatic disease to the bone after 5 infusions of Pluvicto?

[SeosamhM]

Are you saying that you were not metastatic bone multifocal before Pluvicto?

I was before Pluvicto and am still (of course) - I did have some met reduction, but also had some met advance! Disappointing. With Pluvicto becoming part of SOC, I think we are learning a lot about the limitations of PSMA-Lu 177. Most of our cancers are heterogeneous anyway, with PSMA-avid cancer cells living side-by-side with non-avid cells.

Did we just eliminate competition for the non-PSMA-avid cells? That's an unknown. Additionally, my RO did say that they do not understand the reason why even PSMA-avid cells seem to be able to hold on during treatment.

If this is a new phenomenon in your case, check out FionaElbourne's recent post on "3rd Pluvicto update". Lots of responses and thoughts. - Joe M.

[V-Man in reply to SeosamhM]

I discontinued Pluvicto after 3rd infusion. While in treatment my PSA went from 285 to 648, so we re-scanned my body, confirming that my bone mets has advanced significantly. The mets had been held at bay for about 5 years, but there's been an "explosion" of mets throughout my body, incl in my pelvic and lower lumbar areas. I recall reading comments in the literature that it was a possible side effect of the therapy. I did have considerable bone pain that was halted with radiation to lower lumbar- left hip .

I am now on Jevtana & Carboplatin, with 5 more infusions (of 10) to go. My PSA has receded a bit (approv 500), and I'm thankful there are more options for the future.

[Joeym1040 in reply to V-Man]

How were your mets held at bay for 5 years?

[V-Man in reply to Joeym1040]

My initial diagnosis was Stage 4... prior to Pluvicto we did a PSMA scan and my doctor that he felt I had a rather mild advancement of the mets in my bones. I had 2 separate courses of Taxotere prior to the Pluvicto, with 3 dif oral ADT therapies in between. You know how things can go... each patient resounds differently. I'm just glad that they're are still options in front of me. I was negative for all the genetic testing.

[SeosamhM in reply to V-Man]

Yikes. I'm sorry to hear of your frustrating and scary journey with Pluvicto, V-man. I didn't see that literature! It certainly isn't touted much!

I have always been skeptical of the rumored miracle of PSMA-Lu177...there is no free lunch. I remember the absolute frenzy a few years ago, with men traveling the globe for this. But it's just like any treatment - for some it is a godsend, and for others it may actually destabilize their cancer situation.

Keep on keeping on, brother. I expect that I will be on your more-established SOC treatment course before the end of the year. My PSA is not a great indicator for my cancer, so scans will be the deciding factor.

[V-Man in reply to SeosamhM]

Thank you! I agree with your assessment.

[Cateydid in reply to V-Man]

V-man, will you share what additional options you know about in case Pluvicto fails? I’ve asked the onc to schedule PSMA and FDG PET scans after Joe’s 3rd dose on September 15. I’d be happy to be armed with a Plan B if we need it! Thank you.

[V-Man in reply to Cateydid]

I think that Radium 235 was mentioned... we'll see. Unfortunately I was just diagnosed with a DVT in L femur vein 2 weeks ago... oh well. It's not completely occluded

[V-Man in reply to SeosamhM]

Thanks!

[V-Man in reply to SeosamhM]

See image

Ignore the date in the image on R, it's off by a year. Before Pluvicto on L

[robert570]

Had to stop after 3 infusions of Pluvicto with a PSA of 1.95 at the beginning and now after the last one 10.12 Pissed off on that drug.