Finished 6 rounds of Pluvicto 9-1-23. Now on ADT holiday since 1-1-24, psa unmeasurable so far.
During the treatment, had increasingly serious drymouth and nasal congestion and irritation with bleeding, which I attributed to radiation damage. Since then, there has been some, slow improvement, but still not right yet.
I'm using biotene drymouth lozenges and rinse, they provide some relief. Eating dry foods like baked goods (or even potato chips) requires constantly sipping liquids.
Anyone else experiencing these side effects?
(as I tell everyone...'beats the alternative!')
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Kayakbob
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Thanks, TA! I'll check with my ENT re this procedure. Even if I knew this would happen, with no resolution for this, I still would go thru with the Pluvicto treatment.
TA said that permanent Xerostomia is very rare with LU 177 (Pluvicto) but if it happens to you ... And I don't think it is that rare and the damage increases with each treatment. Mine seems to be temporary but i stopped after just three treatments. It is not common but it can be severe to the point that it can interfere with your ability to eat. Xerostomi is one of the most common reasons for discontinuing Pluvicto treatment so the trials are biased in terms of not reporting severe cases. I was constantly asked about dry mouth after and before each treatment so it is known that it can be serious and needs to be dealt with appropriately even if that means stopping Pluvicto treatment.
Yes, this was a problem for hubby. It has improved, but he had dental issues about 5 months after the final treatment. He lost one tooth and needs crowns now on two others. I wonder if he did not consume enough water after each treatment (yes, he was advised 8 oz of water each hour he was awake). His dentist recommended non alcohol mouthwash and mints for nighttime use.
Generally in cases like this we would prescribe sialogogues (meds stimulating salivation) such as pilocarpine, bethanechol or cevimeline. Ask your dentist or physician if a trial of one of these is warranted.
They stimulate the parasympathetic nervous system, so excessive sweating, flushing, some gastrointestinal upset--at least theoretical. I haven't seen it in my patients with normal dosing. They're supposed to be avoided in uncontrolled asthma and glaucoma, uveitis.
I would be less than honest if I said I know the answer to that. A quick scan of the literature turns up nothing WRT effect of sialogogues on renal function. But of course (as they say), "absence of evidence is not evidence of absence". I'd ask the oncologist.
I was just thinking it would probably be bad to take prior or during Pluvicto because it would stimulate more saliva, thus more Pluvicto into the saliva glands. I wonder if there are medicines to slow or stop saliva flow? That may be good during Pluvicto.
Here is ChatGPT answer to that question
”Pluvicto (lutetium Lu 177 vipivotide tetraxetan) is a targeted radiopharmaceutical therapy used to treat advanced prostate cancer. One of its side effects is potential damage to salivary glands, as these glands can accumulate radiation due to their uptake of lutetium.
Using medications to reduce saliva flow during Pluvicto treatment is a strategy that has been considered to limit radiation exposure to the salivary glands. However, this approach is not universally established or widely practiced, and the decision depends on the specific circumstances and the patient’s overall condition. Here’s a breakdown:
Potential Benefits of Reducing Saliva Flow
• Reducing saliva production during treatment could theoretically decrease the amount of lutetium that accumulates in the salivary glands.
• This may help mitigate damage and reduce side effects such as dry mouth (xerostomia).
Options for Reducing Saliva Flow
1. Anticholinergic Medications
• Medications like glycopyrrolate or atropine could reduce saliva flow during or immediately before Pluvicto infusion.
2. Other Techniques
• Sialogogues (saliva-stimulating agents): Sometimes used after treatment to flush the glands and reduce radiation retention.
• Cold Application: Applying ice packs to the salivary glands during treatment may reduce blood flow and radiation uptake in the glands.
Considerations and Risks
• Saliva is essential for oral health, digestion, and overall comfort. Prolonged reduction in saliva flow could lead to dry mouth, difficulty eating, and increased risk of dental problems.
• Anticholinergic medications have side effects that need to be weighed against potential benefits.
• Evidence on the efficacy of this approach in reducing gland damage during Pluvicto treatment is limited.
Current Guidelines
• Some clinicians might recommend preventive measures or treatments based on their clinical experience, but these strategies should always be discussed with your oncologist or a specialist managing your Pluvicto therapy.
Recommendation
Talk to your oncologist about whether medications to reduce saliva flow are appropriate for your specific situation. They can provide tailored advice and might also suggest alternative approaches to protect your salivary glands.”
There are medications that reduce salivation--best known are atropine and similar compounds. But your source says that strategy is not established, and may not help.
Yes, but side effects from all of these treatments are not taken seriously enough to become SOC. Take ADT SE for example why don’t the doctors test E2 and prescribe low dose to eliminate the major side effects.
i am a long ways from needing Pluvicto so it is a curiosity for me at this time.
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After Pluvicto #6 results
Pluvicto Supply easing?
Pluvicto Treatment 
