Continue on Eclipse Trial or not?

[SViking]

After my 3rd LU 177I&T injection my PSA had become nondetectable, and the nuclear bone scans could did not shiw any tumors. Originally had three tumors for spine two very small and one medium. They seem to have disappeared. Given the danger of unnecessary toxins from a fourth injection, the question is, should I do the fourth injection or not?

[Tall_Allen]

I agree. It is toxic when tumor load is too low.

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

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

[SViking in reply to Tall_Allen]

It's such a difficult choice. What if there are still some undetected micro tumors? Then I start all over again. The plan is to start Provenge also. Or is that a waste of time?

[Seasid in reply to SViking]

Provenge is a great idea. I understand that you want the best for yourself but I believe it will not kill micromets and it can only have toxic effects and you are limited how much toxicity you can have. The fight stops when your blood count dropps so much that they will not give you more infusion or treatment. I would try to get Provenge. It is a good idea.

[Tall_Allen in reply to SViking]

"What if there are still some undetected micro tumors? " There undoubtedly are some that don't express PSMA. It is not a cure.

[SViking in reply to Tall_Allen]

So basically the only way to know if I’m cured is to let my testosterone rise and see if my PSA does also?

[Tall_Allen in reply to SViking]

You are not cured. Lu177PSMA is not a cure.

[Seasid in reply to SViking]

Just keep your testosterone low. Don't let it up to see if you are cured. That is too dangerous. Lot of people made that mistake.

[Seasid]

I am not a doctor but I would stop.

[GP24]

The LU 177I&T therapy needs a certain size of tumor lesions to be effective. Even if the nuclear bone scan does not show any mets any more, there are still tumor cells remaining which will cause new mets to appear.

I would stop now to avoid unnessary toxicity and rechallenge with LU 177I&T in the future when new mets show up. ADT will extend this period significantly.

[SViking in reply to GP24]

Thank you. What would be the damage done to me toxicity wise if I took the last fourth shot unnecessarily.

[john4803 in reply to SViking]

For me I began to experience nerve pain, in my back, after the 3rd and even more after the 4th. In the Eclipse study they told me I was getting the same dose as a 400 lb. man. It seems I was being overdosed, perhaps resulting in the nerve pain. But I have no proof of this and the Eclipse Docs. said that I am an anomaly?

Have you experienced any nerve pain? I was given 215 mCi (micro curies) each time. What was your dose?

[SViking in reply to john4803]

205

[CAMPSOUPS]

When there is a low amount of tumors, no tumors, or micro metastasis the lutetium 177 has little to become attached to. It then moves onto healthy organs. In particular can shut down the salivary glands and create issues with kidneys, and possibly liver and spleen.

Tumors or no tumors some guys delvelop deteriorating blood/marrow manufacture with successive Lu 177 treatment.

Sounds like you can save some Lu 177 for a rainy day.

[LongTimeRunning]

I had the same questions weeks ago as part of the PSMAddition trial before my 3rd injection. Prior to the 2nd injection, I had discussed possible toxicity with the Nuclear Med doc if the mets are no longer PSMA-avid. He felt obligated to offer another lower resolution scan the day after the next injection (exact type of scan not specified) that while it couldn't be used for clinical decisions could provide some general information on accumulation of lutetium in organs). Fast forward 6 weeks I had bone/CT scans before the 3rd injection and while reviewing the bone scan with me that he had interpreted, the doc seemed surprised about the way some mets were nearly resolved and others lower in activity. He thought that moving forward with the treatments were reasonable and no need for another scan

My philosophy was to hit hard from the beginning, especially since I am otherwise in great health overall. Maybe it is possible that ADT alone resolved my 21 mm L2 met and some other areas of activity almost completely in about 5 months. Did 2 infusions of Lu help? My PSA before the first infusion was <0.16 and before the 2nd 0.026. It seems that repeat PSMA PET scans would be logical as part of the trial, but bone/CT scans it is. I did read somewhere (trying to track down the ref) that there was speculation that Lu might still be working even where PSMA not being expressed in PMSA PET scan. I don't know if this is true or not, but I went ahead with the 3rd injection.

Long term toxicity is a risk factor. Short term, I am seeing dips in blood parameters and liver enzymes, which get hit after a Lu injection and then slowly recover afterwards to close to reference range. I ask to see the every other week bloodwork to track myself as I will drop out of the trial if the numbers get too worrisome (before the study protocol limits)

The literature provide as a trial did not answer all my questions about the pluvicto side effects, but I found this fairly comprehensive reference which I think is helpful:

ema.europa.eu/en/documents/...

[CAMPSOUPS in reply to LongTimeRunning]

Thanks I follow you on that.

My mantra with "hit it hard" always was/is related to Lupron, Taxotere, and a 2nd generation adt when diagnosed stage 4 at time of diagnosis. But with Pluvitco I feel can back off when there are no more PSMA avid tumors/spots or very little of them to treat. Keep the bone marrow, liver, etc. healthy for a later time when Lu-177 can be administered again if PC is progressing.

[Proflac in reply to LongTimeRunning]

For those doing LU 177 outside this trial is it common practice to do PSMA scans after each dose to check that there are still PSMA avid tumours to treat? To avoid possible toxicity to other organs?

[LongTimeRunning in reply to Proflac]

That's a good question. Not sure. Probably depends on your doc/health plan. In Canada, we still new at the Lu game and PSMA scans are in private facilities (at least on the West coast).

[j-o-h-n]

Cure is spelled manure...........

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 08/24/2023 6:57 PM DST

[SViking in reply to j-o-h-n]

The less you comment on my threads the better.

[j-o-h-n in reply to SViking]

Thanks, I'll remember that.....

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 08/24/2023 7:03 PM DST