Repeat Lutetium/ Pluvicto treatment

[Eugmn]

Hello all, I am just curious if anyone has experience doing additional lutetium treatments. I did three lutetium treatments from September 2021 to January 2022. My Denver oncologist is concerned about bone marrow toxicity , but he does not have enough experience with this treatment to say for sure.

I live part of my time in Colombia and part of my time in Denver, Colorado. Because I am married to a colombiana I am able to be on the Colombian healthcare system. They have a very top-notch new cancer facility a couple hours away from me that I could have all the treatments done for basically no cost. My oncologist in Denver is leaning towards me doing another round of chemotherapy which I did from January 2023 until August 2023.

hoping for some feedback to help me make a decision. Thank you all.

[God_Loves_Me]

I could be 100% wrong.

I was searching for a similar thing in another group. Pluvito salesperson confirmed the doctor. Patients can go with multiple treatments. Also, pluvito is doing multiple trials for the same as well.

I think the doctor at Colombia's health system is the right place to start a discussion.

[Miccoman]

I know everyone has a different reaction and a different plan.

That said, I wonder why you are not back on Pluvicto? I just had my 5th of the 6 injections, spaced 6 weeks apart. If you do go back on be sure to get the doctor note about being radioactive so you can still fly without an "invasive" procedure looking for the source! LOL

My PSA has dropped from a peak of 106 to 14. And my Alk Phos from 320 to 130 (as I understand it, Alk Phos shows there is a problem in either liver or bones). Very minimal side effects and I'm feeling markedly better (no Lupron, as had the orchiectomy like you).

I have always, since 2014 when diagnosed at least, had marginally low RBC -- doesn't seem to change much. So unless your mets are in the marrow I don't see what your MO is worried about. Mine are all in the bone, BTW.

[Eugmn in reply to Miccoman]

thank you for your reply. Sounds like we have similar situation. But my dilemma is the fact that after I did lutetium my PSA drop down very low and then within two months after my PSA shot back up again. Situation with the chemo I had 10 rounds of chemo. PSA dropped very low and then two months after everything shot back up again.

[Miccoman in reply to Eugmn]

After Xtandi stopped working my MO had me do as much chemo as I could take then go on 6 rounds of Pluvicto.

I see you did 3 Pluvicto in 2021-22, then chemo last year. According to drugs.com/history/pluvicto.... Pluvicto was not even approved until March 23, 2022! So I don't think you had Pluvicto, especially since the FDA requires chemo before you can do it. Maybe you got the dates reversed? Maybe you had Radium 233?

Also checking bone marrow toxicity for Pluvicto I find only this NIH article ncbi.nlm.nih.gov/pmc/articl... that says it's really not much of a problem. It does seem that Radium 233 is more of a problem: ncbi.nlm.nih.gov/pmc/articl...

I think you really, really need a second opinion on your treatment plan. If you are just batting down the cancer, then stopping and it comes back eventually it will mutate into something they can't stop. The only reason I've ever heard of stopping Pluvicto was if PSA kept rising or side effects were too severe.

Good luck, and as always YMMV!

[Eugmn in reply to Miccoman]

Thank you for the reply. For clarity I had my Lutetium dome in India before it was approved in the US and I had it before chemo.

[Miccoman in reply to Eugmn]

Oh, lucky you! Things seem to be moving in the direction of PSMA-based treatments earlier in the program. There are 2 more versions in clinical trials with different radioisotopes.

My 2¢: Based on your non-SOC (standard of care) treatments I would really encourage you to get a second opinion from a major cancer center -- you can probably do a tele-medicine visit with, say MD Anderson. My doctors are all at the local university medical center but when I can't decide what to do, I tele-med to MSK in NYC for another look at the situation.

[Hidden]

This guy has….

healingwell.com/community/d...

[Eugmn in reply to Hidden]

Thank you so much for that link. I read all of it. That gentleman success is very inspiring.