I recently attended a prostate cancer support group meeting in metro Vancouver where a radiation medicine specialist talked about options for prostate cancer theranostics in our province of British Columbia. I was surprised to learn that Americans can come up here and get Lutetium 177 PSMA treatments…and it is less expensive then at most other sites in the world, including ones in the USA.
This was new to me. If you're had Lut 177 treatment in Vancouver, could you let me know what you thought of it in terms of both convenience and cost?
Thank you.
Richard W.
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Wassersug
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That exchange rate is indeed better than what I pulled up on line. Still the question is: Has anyone from the USA come to Vancouver for LU-177 that they paid for out of pocket...and how did that compare to options elsewhere on the planet?
Good to talk to you again. We have met many times. I am receiving Lutetium-177 through the BC Cancer Agency as part of a clinical trial. The trial is called SPLASH and the ligand they are using is PNT 2002. Four infusions. There is no cost to me other than frequent trips in and out of Vancouver. No dry mouth, no nausea, no sickness. No side effects whatsoever.
i am in Vancouver advanced pc including lymph nodes..had PET scan..aberaterone lupron and pred working well for last 9 months…would it have to stop working ie T and Psa rising to be eligible for Lutetium ?
Zytiga (abiraterone) plus Prednisone is a Tier Two drug. Along with the Lutamide family of drugs (Enza, Daro, Apa and others) Zytiga belongs to a class of drugs known as Androgen Receptor Pathway Inhibitors or ARPI drugs. Normally, Lutetium is prescribed when ARPI drugs begin to fail. This is demonstrated by a rising PSA and evidence of progression on scans. Also keep in mind the cancerous prostate cells in your body must have Prostate Specific Membrane Antigen or PSMA on their surface in order for the Lutetium to work. Not all PCa cells do. In your case, you seem to be doing quite well on Zytiga so I doubt you would be eligible for Lutetium. Hope that helps!
The costs of $18,300 per infusion would be for a private pay. Outside of the SPALSH or any other trial. So, one could get in quickly. If the price is the same, it seems easier to come to Vancouver than go to Germany, particularly if one is in the western part of the USA.
Being outside of a trial, it looks like one could negotiate to get LU 177 PSMA in advance of ADT (!). I'd be interested in hearing what folks think about that option...
As TA implies, Initio requires a Doctor's referral (MO) and Initio can only accept a script that complies with Health Canada approved indications - which I point out below.
The Health Canada approval of PLUVICTOTM is based on the results of the pivotal Phase III VISION trial which randomized patients with PSMA-positive mCRPC who received 177Lu-PSMA-617 in addition to best supportive/best standard of care (BSC/BSoC) versus patients treated with BSC/BSoC alone.
PLUVICTOTM (lutetium (177Lu) vipivotide tetraxetan injection) is indicated for the treatment of adult patients with prostate-specific membrane antigen (PSMA)-positive metastatic castration-resistant prostate cancer (mCRPC) who have received at least one androgen receptor pathway inhibitor (ARPI) and taxane-based chemotherapy
There are members in the HU world who have traveled to India to obtain radioligand LU 177 infusions. The cost in India is substantially less expensive than getting the infusions in Australia, Germany, or GB. The facility in India arrange for lodging and meals while the infusions are done, but it becomes the patient’s responsibility to pay the cost of traveling to New Deli and getting to and from the airport. I have discussed this with a HU member who has gone twice to India for treatments for a total cost in the range of $10K to $12K. Private message me if you wish further information.
I have been told that India is still cheaper than Vancouver, but, again, I am hoping to here from anyone from the USA who has been treated in Vancouver.
I started Pluvicto at the London Clinic during the period when it was unavailable in the US. It was about $14000. Fortunately, subsequent treatments have been at Duke. I have had very good results with 4 treatments so far.
Richard Wassersug wrote: „Being outside of a trial, it looks like one could negotiate to get LU 177 PSMA in advance of ADT (!). I'd be interested in hearing what folks think about that option...“
I prefer metastases directed therapy, I just do not like to know that I have visible mets in my body. I had my lymph node mets radiated successfully with SBRT but without ADT new ones appeared within a year. That time there were more than five mets and the RO did not want to treat these with SBRT but refered me to ADT. You have an advantage in Ontario because Dr. Palma in London will treat up to 30 mets with SBRT. oicr.on.ca/researchers/davi...
I managed to find a nuclear physician who agreed to treat my lymph node mets with Lu-177. I combined that with Bicalutamide because antiandrogens can increase the PSMA expression for the Lu-177 therapy. I asked for a PSMA PET/CT after the first cycle and all the lymph node mets were gone. Side effects were some fatigue for a few months.
However, you should combine metastases directed therapy with ADT to avoid a quick recurrence and probably extend the effectiveness of ADT. Because I had lymph node mets only I follow the Swedish style and use Bicalutamide. I had my breast radiated and use Tamoxifen with it. In the US you could follow the Embark trial and use Enzalutamide. urotoday.com/video-lectures...
I traveled to Austria for Actinium and Lu-177, 3 treatments in all. It was expensive(had help of friends), prior to treatment with ADT. Was prescribed Orgovyx concurrent with treatments and for some months after. It was very effective in my case. No sure about long term results, but had mets all over and last scan in January showed only one small spot. For some am told that immune system can become more effective following Lu-177. Due for another scan in a couple of months.
May I ask your age and whether the pluvicto relieved pain in spine and lower back? My Dad is 87 and in good health except for metastatic prostate cancer. He did docetaxel summer 2023; Jan to Sep 2024 cabazitaxel and now will do Pluvicto. He never had any nausea or trouble with treatment. Some nodes in lungs, none to organs, spine and pelvis metastasis only; only recently fatigued, loss of appetite; and some dry mouth but he always has had low RBCs which they will monitor. They say he is a good candidate for Pluvicto and he wants to try it.
As with all of us, my situation was a bit different than some who have posted. I had extensive mets, but was still hormone sensitive which is why I had to leave the country to find this treatment. Some of the mets were to bones and I had some pain in my right hip. I was first given Actinium 225, specifically to target the bone mets. My cancer had spread after an immunotherapy failed and cancer spread-PSA went from 70 to 280 in a few months. Following Actinium treatment Psa dropped to 7 within a month and after 2 LU-177 treatments, was well below 1. Pain in hip went away. I experienced some nausea, resolved with infusion of prednisone and a couple of other things. Also had some fatigue. Dr. asked for drinking 2.5 liters of water a day. I was given xylitol candies to hold in my mouth to stimulate salivary glands for the first few days following treatment.
That was last year between June and October. This year PSA began climbing and PSMA scan showed renewed cancer activity. I am about to go for third treatment this year. PSA was 35 before first treatment this year in August. Was down to 8 in September before 2nd treatment and will have another PSA next week before 3rd treatment early in November. Have experienced some nausea, dry mouth and fatigue. All in all not too bad.
I wish your dad well and much success with LU-177. If I can give you any more information please get in touch. All the Best!
Mbnm asked me in a separate message about the regulations in BC for getting access to Lut 177-PSMA. To thebest of my knowledge that depends on whether one is in a research study or not, and whether they are willing to pay out of pocket or not.
All I know is we see our Medicare statements. Our Nuclear shots are being billed at 48K. Medicare pays 41K and our suppliment pays the remainder 100%. Can you believe it!
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