Lutetium

[Doggedness]

Hoping to get some idea of how effective the Lutetium 177 is. I have a few friends who have tried it but perhaps too late and it only worked briefly. I recently read that it is a palliative drug rather than an early option for therapy… Is there anyone out there who has had long term benefit from Lu-177?

[RyderLake2]

Hello,

That has not been my experience at all. In most of North America, Lutetium has only been approved for use after chemotherapy. I was lucky to be accepted into a trial investigating using Lutetium pre-chemotherapy. Big difference. I have had no side effects, nothing only a little fatigue. The downside for me is being highly radioactive and spending the better part of a week isolated in the basement. I have had three infusions with a fourth scheduled for the end of July. I am actually surprised that you asked this question because the doctors at the Peter McCallum centre in Melbourne are huge supporters of radiopharmaceutical therapy and the theranostics approach for metastatic castration-resistant prostate cancer (mCRPC). Lutetium does not work for all men but for some the results are miraculous. Many studies coming out of Australia and elsewhere show that Lutetium leads to better outcomes when initiated before chemotherapy in taxane-naive patients. My advice is to give it a try. Hope that helps!

[Doggedness in reply to RyderLake2]

I am not sure why you are surprised I asked this question. I wanted first hand answers to something I was wondering. I thought the purpose of this platform was discussion. I know Peter Mac is big in prostate cancer care and I know of at least one lady’s husband who had the treatment there, but he passed away some time ago, so I don’t feel right asking her how long he survived post lutetium. The 2 other men who I know had lutetium, died shortly afterwards. I believe that both ended up with the cancer in the marrow of their bones.

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

Go easy Madame......don't bite the first hand answers that feed you....

Good Luck, Good Health and Good Humor.

j-o-h-n

[Tall_Allen]

Are you near Melbourne? Peter Mac is a world-renowned center for radiopharmaceuticals.

[Doggedness in reply to Tall_Allen]

We are near Melbourne, but my husband is doing well so far, so it was just a question for the future. The few people I know who had Lutetium, had it as a last resort, so while the first deliveries of the isotope seemed to work well, the benefits didn’t linger. There was some discussion that if the litetium was administered earlier in the life of the cancer it might add more years to a man’s life.

[Tall_Allen in reply to Doggedness]

One shouldn't make decisions based on anecdotal info when there are actual clinical data on thousands of patients.

[Doggedness in reply to Tall_Allen]

Thank you for your reply. I agree with you. I just hadn’t heard of anyone who had had it early in their medical journey. I agree that clinical papers and conversations with doctors are a better basis for decisions and have read some studies, but was just wondering if I could find anyone who had had success (the papers are very heavy with terminology). It was actually my husband who suggested I ask on this forum. If you know of any clinical papers that discuss early lutetium options (compared to lutetium as a last resort), I would love to know how to find them! I have looked on Google Scholar but have not found what I was looking for. I know everyone is different in the way they respond too, so what works for one person might not work for someone else.

[MJCA]

Hi,

I am currently undergoing Pluvicto treatment; I have completed 5 of the 6 cycles. Prior to commencing treatment, my PSA was 29.29. My PSA at its nadir was 14.47. After cycle 3, I had a PSMA-PET. It showed all metastases except for one were receding or dying. My PSA has been on a fast upswing. Prior to cycle 5 of Pluvicto, my PSA had reached 33.50.

Inquiries with this group (thanks, as always, Tall_Allen) informed me that as tumors die, they release PSA. Currently, my PSA has a doubling time of about 9 weeks. At this juncture, we feel a PSMA-PET is warranted now, rather than waiting until after cycle 6. I am hoping the fast rise in my PSA, is due to tumors dying. I will know more in a few weeks.

[Doggedness in reply to MJCA]

Thank you, and best wishes.

[ARIES29]

I had 2 Lutetium 177 shots years ago here in Australia & when they found out I had not had chemo they cancelled third one. It reduced PSA from 19 to 1, so it worked but PSa came back up after 2 years so it is not the silver bullet cure.

[Doggedness in reply to ARIES29]

Thank you, and I am so sorry they stopped before giving you the third in the series. Hopefully they will find something that works well (stating the obvious). All the best

[Cenerus]

I’ve done a lot of study of the various radiotherapies like Pluvicto.

The short answer is that Pluvicto is good at initially shrinking tumors greater than .5cm but it’s not very effective against micrometastacy of under .5mm. That’s because the beta particles it emits tend to have traveled about .7mm before they can collide with something. This means that micromets and single floating cancer cells are mostly underexposed or unaffected by Pluvicto. This is a problem for any Beta emitter that only emits Beta particles. So Pluvicto has a tendancy to have low durability because it doesn’t do well against small mets. The current version also seems to be sensitive to have much PSMA the cancer is expressing. This may have something to do with how well the drug binds to PSMA. Patients that express a lot of PSMA are helped more by Pluvicto.

There are newer isotopes being used in early trials that deal with this by either emitting Alpha particles, which are vastly more massive than Beta particles and act over very short single cell distances (Actinium or Astatine). Or they use an isotope that emits Beta particles and auger electrons which act over short distances in a way similar to an Alpha particle (Turbium-161). These newer isotopes have the ability to kill both large and micro tumors and cells. There’s also a drug in development that uses Copper-67 which is a Beta emitter like Lutetium. But this drug uses a different molecule to attach the drug to the target cells that makes it hang longer and this drug also has a better molecule that holds the isotope which also keeps it from breaking away and causing toxicity elsewhere this drug is showing much better early results than Pluvicto. Maybe getting into a trial of one of these second generation drugs has potential for a more durable remission than Pluvicto

[Doggedness in reply to Cenerus]

Thank you for that! My mother went on a trial for triple negative breast cancer and is doing well many years later. It is encouraging to hear of new treatments in the pipeline! Best wishes for your journey

[SViking in reply to Cenerus]

I went through the eclipse trial about a year ago with a PSA of 3.3 and it went down to .25 prior to the last injection. After that, it started to rise again. I haven’t found anybody who kept their PSA down for very long after treatment. And I also did the trial before chemo. I’ve heard that in Southern California there are clinical trials with the Alpha version but also a strong potential for damage to teard ducts and saliva glands. Do you know if this is true with all other alpha versions?

[Cenerus in reply to SViking]

Damage to tear ducts and salivary glands is a danger for both alpha and beta emitters. It’s called xerostomia. Bayer is beginning a phase 1 trial of a new Alpha emitter drug that hopes to reduce this issue. Their drug uses Actinium, but adds a molecule that is supposed to keep it from entering the salivary glands and tear ducts.

[SViking in reply to Cenerus]

That would certainly be a game changer.

[Doggedness in reply to Cenerus]

Thank you. I didn’t know that. Best wishes!

[Doggedness in reply to SViking]

Thank you. You are the only one I have read about to try it pre-chemotherapy. I wish you all the best.

[ulfhbg]

Hi !

Saw your post and I’ve been treated early on with 3 cycles of LU-177 as part of a ’salvage package’ after a failed HDR Brachy mono therapy in 2022

I went to Finland at the end of 2023, to a private clinic and had tests and two different type of PSMA Pet scans and I was a T3BN1M0.

Before start of first cycle of LU-177 my PSA was 5.8.

After first cycle and before I was put on ADT(Firmagon),in January 2024, I had a big PSA flare which measured 9.8

In time for next cycle in the end of January my PSA was 2.26.

I had the third cycle in the end of February and at that time my PSA was 1.0

In the beginning of March I started 20 hypofractions with VMAT RapidArc

When finished in the beginning of April I then added Abiraterone and Prednisolone together with Firmagon in mid of April. PSA at that time was 0.55.

In the mid of July i had my first 3-month PSA after external radiation, ADT and Abi and the PSA was <0.1

Shortly after that I changed from Firmagon to Orgovyx

I will have my 6-month PSA now in the middle of October and it’s stressing me out totally and I feel anxious every single day.

But to summarize, i have been treated early on with LU-177 but I will have to wait to see if any long-term results. What I also can say was that the 3 cycles of LU-177 by far was easiest part of the whole ’salvage package’ when looking at side effects.

I think that the profile Brysonal have done LU-177 early on in his treatment path.

Best wishes - Ulf

[Doggedness in reply to ulfhbg]

Thank you so much for that!! I have heard people here say they wished it was an early option. I am keen to see a study on whether it is better to have Lu177 as an early choice of cancer control rather than a later one.