pluvicto

[Z06driver]

has anyone used this

I just listened to a podcast where they claimed 88% success with stage 4 prostate cancer. He said it it used everywhere but not much is USA

Hard to believe it’s that good and our doctors don’t use it

[RyderLake2]

Hello,

I am taking it. I have had two infusions so far. No side effects whatsoever other than a little drowsiness. It was approved in North America in 2023 but only after chemotherapy. There are a number of clinical trials going on looking at Lutetium-177 pre-chemotherapy. I am on one of them. I am not sure where you got your statistics. I was told that for about 1/3 of the men who receive it the results are miraculous, the next 1/3 the results are so-so, and for the remaining 1/3 it doesn't work at all. Remember, Pluvicto (lutetium) does not work at all if you are not PSMA avid. You are right radiopharmaceutical drugs are used extensively in Europe, Australia, South Africa, India and elsewhere but it is not the silver bullet. Hope that helps!

[dhccpa in reply to RyderLake2]

I thought it was approved in US before 2023, but maybe I'm thinking of the scan.

What qualifies a person as PSMA-avid? I know some PCa cells don't express PSMA, but don't most cells in most people?

Also, is Pluvicto primarily radiation based, such that it zaps individual places? If so, how can it be a systemic therapy?

Or is my understanding incorrect? Thanks for your input.

[SeosamhM in reply to dhccpa]

Pluvicto is systemic in that it is administered like traditional chemotherapy in a fluid form factor - through slow venous injection. Therefore it is indeed systemic.

Pluvicto is clever. The drug is primarily made up of a carrier molecule made with PSMA (a "ligand") with a radioactive Lu177 molecule chemically attached. PCa cancer cells that have a binding site for PSMA on their cell membrane get a close-out bombardment by the very short-lived Lu177 radiation. There is, of course, bombardment of other cells in the area, but in a lot of cases, these also will be PCa.

[dhccpa in reply to SeosamhM]

Thanks that was very helpful.

[RyderLake2 in reply to dhccpa]

Hello,

I will try and clear up any misconceptions. First, you are right Lutetium and PSMA PET scans were approved by the FDA in March, 2022. Second, Lutetium (which is sometimes marketed as Pluvicto) is a systemic treatment. It enters the body through an infusion into your arm. It specifically targets a molecule on the surface of prostate cancer cells called PSMA. This therapy is used with a PSMA PET scan. The scan is used to identify cancer that makes the PSMA molecule. It is part of a new type of therapy called "theranostics" an interesting word made from combining therapy (Lutetium) and diagnostic (PET scan).

So how does it work? PSMA is what the radioactive molecules Lutetium-177 PSMA and gallium 68-PSMA (scan) attach to. They do this by way of a ligand. Pluvicto uses a specific type of ligand which they have copyrighted and have exclusive rights to. There are others.

During treatment, the PSMA grabs on to the Lutetium-177 PSMA; the radiation it carries is absorbed into the cancer cell, damaging its DNA and ultimately causing cell death. Not for everyone but in my humble opinion this therapy extends the quantity and quality of life for patients who otherwise would have limited treatment options. Hope that helps!

[dhccpa in reply to RyderLake2]

Thank you. I did have a wrong understanding of exactly how it works.

Regarding whether a person is PSMA-avid, does that have to do with one's total percentage of PCa cells that express PSMA? I've understood that most PCa cells do express PSMA, while a minority don't. Does it boil down to percentages, or do some have no cells that express it?

[RyderLake2 in reply to dhccpa]

Hello,

Some men have cancerous cells that simply do not express PSMA. I believe less than 10%. Fortunately, the vast majority of men are PSMA avid and good candidates for radiopharmaceuticals like Lutetium.

[MsHope in reply to RyderLake2]

I just saw your post. I am sharing my post regarding my husband, in hopes you have some info. Would appreciate any replies regarding Pluvicto treatments and side effects.

I have read you cannot be close to family members or pets for awhile after treatment. I hope this is not true. I would be almost impossible to do.

Yesterday had follow up appointment with his oncologist to go over scan results.

Doctor said obviously the Docetaxel did work some but not enough. Next treatment will be Pluvicto.

Pluvicto treatment if available in Houston, which is about 150 miles, one way from where we live.

My husband had his first chemo treatment of 275ml Docetaxel (Taxotere) on 1/11/24 and his 6th and last treatment 4/21/24.

My husband had his PSMA PET/CT last week and overall it was good.

Right frontal skull SUV 5.3 previously 0.75, C3 SUV 22 previously 13.9, right clavicle 9.23 previously 23.6 clavicle 3.0 previously 13.0 left humeral head 32 previously 36.3 right humeral head 10.3 previously 18.6, sternum 21.2, previously 31, L1 25

previously 31.2, sacrum 24.3 previously 34.6, Left anterior trochanteric femoral activity SUV 24 previously 23.5 - the volume involved has increased.

Last month my husband's PSA decreased 1144 points to 586. This month it increased to 1658.968 NG/ML. 1072 point increase. This is difficult to believe the difference.

Thank you in advance for any info

[God_Loves_Me in reply to MsHope]

I think Tall_Allen mentioned in other post that try to do FDG and PSMA scan before pluvicto and that will tell us whether pluvicto going to help or not.

[MsHope in reply to God_Loves_Me]

Thanks for your reply. My husband had his PSMA PET/CT last week and overall it was good. Doctor said obviously the Docetaxel did work some but not enough. Next treatment will be Pluvicto.

[God_Loves_Me in reply to MsHope]

Agree request for FDG scan

[RyderLake2 in reply to MsHope]

Hello,

Sorry about the delay in responding. The first thing you need to know is everyone is different. My side effects might not be the same as your husband's. Saying that I had no serious side effects from Lutetium other than a little fatigue. No dry mouth, no nausea, no pain...nothing! The biggest problem for me was being radioactive. The Cancer Agency where I had the infusion is about 110 kms (65 miles) from where we live. My wife had to drive and I sat in the back seat of our car on the passenger side. The rule is that you must stay at least one meter or three feet away from friends and family. No contact with pets, pregnant women, or kids. Not able to share a bathroom or a toilet.

The doctor giving the infusion said no sleeping with my wife for a week. Consequently, when I got home I became "a basement lab rat!" Before you feel too sorry for me, we have two bedrooms downstairs, a separate bathroom, shower, toilet etc. The basement also has a den (my man cave) with a large screen television (for hockey games) and lots of reading material. Was I lonely? A little but for me it was manageable. I went upstairs to eat dinner. Breakfast and lunch were often left at the top of the stairs. My wife bought a geiger counter, when we got back from the Agency it went nuts. Told me to move outside immediately and contact the government! 😊

Each day the radioactivity went down as the Lutetium was expelled from my body by peeing. By the end of the week I was not radioactive at all. I have had two infusions so far and each one gets a little easier. Here is the big difference. In North America you are only eligible for Lutetium-177 PSMA therapy IF your prostate cancer has spread beyond the prostate and progressed after trying other therapies (including hormonal therapies and chemotherapy). In other words, after chemotherapy. In my case, I am on a clinical trial looking at Lutetium pre-chemotherapy. In other words, as an alternative to chemo. In many other parts of the world like Europe, Australia, India and elsewhere it is a viable alternative to chemo. One can only hope that happens here.

Your husband has an aggressive form of prostate cancer. His PSA is extremely high and he might be running out of viable options. Lutetium is not the proverbial silver bullet but for about 1/3 of the men who take it the results are miraculous. The down side is for the next 1/3 the results are so-so and for the remaining 1/3 it doesn't work at all. Hoping for the best! Hope what I have written helps and good luck!

[KocoPr]

you can use the search feature and you will find a lot of posts on it.

[WisdomSeeking]

As commented by other users - please use the search function. There are also side effects with pluvicto.

Also you may check out the posts on Tall Allen's blog:

Pluvicto does not work better if used before docetaxel in mCRPC

prostatecancer.news/2023/09...

Pluvicto+Xtandi Delays Progression Better than Xtandi-alone in mCRPC

prostatecancer.news/2024/04...

[Ramp7]

I went through a Trial Study at Dana Farber two years ago. I had no Chemo prior to. Initial results were very positive, PSA down over 90%. But after 6 infusions, PSA slowly crept up.

[rsgdmd in reply to Ramp7]

Seems like even for those who get good results, its often not durable.

[Ramp7 in reply to rsgdmd]

One has to look at the long term success. Those results I am not aware of. Presently doing BAT.

urotoday.com/video-lectures...

facebook.com/groups/8909068...

[EdBar]

Pluvicto was FDA approved in March 2022, it is very effective for about a third of those treated, a third get some benefit and not effective at all for a third.

Ed

[j-o-h-n]

Greetings Mr.Z,

Would you please be kind enough to update your bio here on H.U.?

E.g. Age? Location? Treatment(s) to date? Psa score(s)?, Gleason score? Medical procedure(s)? Doctors' name(s)? , Meds? Treatment facilities and any other pertinent information.

This information helps us and helps you too.

Thank you!!! You came to the right place for info and camaraderie.

Good Luck, Good Health and Good Humor.

j-o-h-n

[monte1111 in reply to j-o-h-n]

Just the facts Mr.Z

[Z06driver in reply to monte1111]

What’s that supposed to mean

[monte1111 in reply to Z06driver]

Obscure. Dragnet. "Just the facts, ma'am." Taking a shot at j-o-h-n. He's very good at ducking. He also waddles.

[j-o-h-n in reply to monte1111]

Well my name is Donald Duck and I don't give a flying.........feather.

Good Luck, Good Health and Good Humor.

j-o-h-n

[j-o-h-n in reply to Z06driver]

Humor man...... Humor. Like Z is for Zilch.....

You came to the right place for info and camaraderie.

Good Luck, Good Health and Good Humor.

j-o-h-n

[monte1111 in reply to j-o-h-n]

I'm sure you've seen the infamous interview with David Letterman and Joaquin Phoenix. Classic.

[j-o-h-n in reply to monte1111]

I don't think so ..... but I'll try to find and view it.... Thanks

Good Luck, Good Health and Good Humor.

j-o-h-n

[Yank66]

DH had a good response to Pluvicto with a 95% drop in PSA and shrinking of metastatis. Because his PSA has risen after 8 months, he will have two additional infusions which insurance has agreed to cover. Fatigue was his chief complaint. You must take precautions for exposure. Doctors will inform you what you need to do. It’s sometimes challenging, but doable.

[Reltubs in reply to Yank66]

Have had my third Pluvicto treatment PSA is down significantly! Only side effect is fatigue. I overcome that with 20 mg of prednisone daily! I am a 74 year old farmer still working 12 hours a day. Just planning on going hard until I’m gone!

[pe43]

Here is a diagram showing how Lu177 treatment works. Lu177 gives out β (beta) particles, which are electrons, they damage DNA in the cancer cells and kill them. There are also γ (gamma) rays emitted, which are used for imaging.

Pluvicto