Ra 223 (Xofigo) after Lu 177 (Pluvicto) anyone?

[cancervictim]

Our MO is questioning the efficacy of Ra 223 as next step after Lu and Docetaxel. All hubby's biomarkers suggest he can complete Ra 223 and benefit from it.

MO cites the cost of Ra and the lack of evidence regarding the efficacy of Ra after Lu as justification to go to Cabizataxel as next treatment.

Anyone have Radium after Lu 177?

Thank you in advance!

Wife advocate

[Tall_Allen]

By combining Xofigo with docetaxel, it allowed for a lower dose of docetaxel. (see chemotherapy section in the link below)

prostatecancer.news/2021/02...

These studies looked at Pluvicto after Xofigo:

jnm.snmjournals.org/content...

ncbi.nlm.nih.gov/pmc/articl...

This trial in Australia is combining them:

clinicaltrials.gov/study/NC...

[cancervictim in reply to Tall_Allen]

Thanks for your response Tall Allen. I'm aware of the studies reporting on the sequence of Lu after Ra. However, my husband had the opposite sequence -Lu/Pluvicto before Xofigo.

He did a Pluvicto trial pre chemo. He had no bone mets at that time so Xofigo wasn't offered.

I know that Pluvicto is a beta emitter and Xofigo is an alpha emitter. Is it logical that treatment with one wouldn't affect efficacy for the other in either order since they act differently?

[Tall_Allen in reply to cancervictim]

I have read suggestions that Pluvicto is better at lymph node metastases, and Xofigo is of course only effective on bone metastases. But there has never been a clinical trial.

[dhccpa]

Why is your MO concerned about cost? Do you have insurance or Medicare to pay for it?

[cancervictim in reply to dhccpa]

Lol, well good question. We are in a public health care system. My sense is that cancer doctors are lectured frequently on cost of care.

[dhccpa in reply to cancervictim]

Ahhh--cost rears its ugly head! Nice to have a treatment that no one uses!

I am really struggling to find a provider of Provenge in my area (or outward so far).