deciding whether to do pluvicto with hemoglobin around 8

[LJGD]

Metastatic prostate cancer to multiple lymph nodes, lungs, bone Mets to spine, ribs, pelvis, femur. PSA 22. Gleason 9. ADT for 7 years, failed zytiga after being on it for 3 years, failed 3 rounds of doxetaxol this past fall. Radiation treatments to pelvis in 2021 and spine, hip in 2023. Had BRCA mutations so tried Lynparza January 24. Had horrific side effects from the get go: extreme fatigue, nausea, brain fog, drop in hemoglobin, unable to eat or drink. After 3 weeks on it, got a DVT so decided to stop treatment since there was no quality of life. Bone pain improved on Lynparza, but new lesion on bladder wall developed that is now causing bleeding so they had to go in and cauterize some bleeding vessels as a bandaid. On Eliquis for DVT. Hemoglobin hovers around an 8 after multiple blood transfusions. Oncologist wants to try pluvicto next but am worried about it dropping hemoglobin levels further and causing more fatigue and weakness. Thoughts?

[God_Loves_Me]

my Hemoglobin was 8 and dr started IRON IV to increase my hemoglobin and get me upto 10. At same time there were no other treatment.

[Tall_Allen]

Maybe it will come back up after the cautery and recovery from PARP inhibitors. Anemia is the most common SE of PARP inhibitors.

[Mcrpca]

My husband’s hgb is running about 8 after 4 Pluvicto treatments. The value the Theragnostics team is most concerned about is absolute neutrophils. That needs to be >1.0. Side effects for him have been negligible until 2 days ago. Hematuria that responded promptly to hydration. If you do decide to do Pluvicto, drink LOTS of water!

[LJGD in reply to Mcrpca]

That’s good to know! How has it been with the precautions for the first 3 days after treatment as far as distance and everything else? My dad has incontinence so will have to dispose of pads.

[Mcrpca in reply to LJGD]

Isolating has been difficult because my husband also has some dementia so he forgets. Your dad will need his own bed for 3-4 nights and ideally his own bathroom. Linens need to be quarantined (use a plastic bag) and washed separately. I run them through twice. Especially wash cloths and towels. You should probably ask the Theragnostics department for suggestions. They would have a lot better suggestions especially for dealing with incontinence products. If you’re close to the treatment center they may be able to handle your contaminated waste. I have to continually remind my husband to keep his distance, especially from grandkids and great grand babies 😳.

Have him drink LOTS of water. I can’t stress that enough.

Good luck to you.

[LJGD in reply to Mcrpca]

Thank you! This is helpful. My mom has to help my dad get back into bed a lot so will also have to see how long she can be closer than 3 feet to him. I know that limiting your time in close proximity to him is ideal.

[Mcrpca in reply to LJGD]

I’m certainly rationalizing but I’m almost 80 years old and as I understand it, the risk of exposure is for developing some form of cancer in 15-20 years. Since I have to drive 6 hours from the treatment center home, it’s hard to maintain the requisite distance. I do what I can, sleep in a separate room and use a separate bathroom, which I understand is a real privilege, and try not to worry too much about a future that I may or may not have. Please ask for specific instructions and work-arounds from your Theragnostics team. Good luck!

[OldWarrior]

Another form of supportive care for low hgb is epoetin alpha, brand name Procrit. If I get down to 8 I really start feeling weak/fatigued.

[Retireddoc]

I believe this sort of specific question really can't be answered on a forum like this. A specialist needs your complete history, labs and physical exam to make a recommendation. People are certainly being helpful by replying about their individual experience but that is anecdotal. It may or may not have any bearing on your individual situation. The best course of action is to ask your MO and the specialist that will perform the procedure your questions. I am sure they have experience with this and can give you informed answers.