Pluvicto fail - what's next

[1031Cancer]

My husband finished 3 rounds of Pluvicto and each time his PSA has risen. He just had a PSMA scan yesterday which showed an increase in the bone mets. We talked with his oncologist last week and asked what his next step could be if it's decided to stop this treatment. She mentioned another chemo treatment - cabazitaxel. Has anyone in the group had similar treatments and how did the chemo help after previous fails.

His history, diagnosed in 2022 with stage 4b with mets to the bones - 6 spots. He's on Lupron for life, started with Zytiga and that worked for a time and then he became resistant, had 5 rounds of chemo Docetaxel and that failed, went to Pluvicto and we are pretty confident he's had his last dose.

His PSA is currently at 119

PSMA test results:

CONCLUSION:

1. Worsening osseous metastatic disease.

2. Small left pleural effusion.

3. Right renal artery aneurysm measures 2.0 cm. Previously measuring 1.8 cm.

Thank you.

[Tall_Allen]

Consider combining Xofigo with a lower dose of Jevtana. as in the following trial with Xofigo and docetaxel:

ejcancer.com/article/S0959-...

Also consider adding Provenge.

[1031Cancer in reply to Tall_Allen]

Thank you. I'll add this to the questions when we talk with his doctor.

[Tall_Allen in reply to 1031Cancer]

I suggest you email him the link above now and this one with a note saying you would like to discuss these at your next meeting.:

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

[1031Cancer in reply to Tall_Allen]

Thank you for the suggestion. I will do this and see what she tells us. Fortunately, she has always been open to anything I/we find and ask about. To my surprise, she knows exactly what I'm asking about that's come down or is coming down the pipeline in regard to new treatment options. I really appreciate your input. Looks like you are very knowledgeable on this unfortunate subject.

[Bigdo58 in reply to 1031Cancer]

TA is a god in this space. His advice is golden.

[NanoMRI in reply to Bigdo58]

If this is an open forum, and about 'unlocking' health, it needs to be said not all members share your view. All the best to all of us fighting this beast!

[Bigdo58 in reply to NanoMRI]

Point taken, but we are not here to make points. All the best.

[TomMaloney in reply to 1031Cancer]

I had 6 cycles of Pluvicto {failed}

I had 6 cycles of docetaxel [failed]

I had 8 cycles of cabazitaxel/jevtana along with 3 cycles of carboplatin.

my PSA is 1.1 and all tumors have shrunk to 1/8 their previous size.

[MydogBrandy in reply to TomMaloney]

my husband is on Nivolab immunotherapy fortnightly and cabometyx tablets daily , the oncologist said on Monday the cancers are shrinking but he is so so poorly. Feeling sick and sleeping all day . You seem to have a lot of knowledge I wonder if you have heard of this treatment? Thank you

[billyboy3 in reply to TomMaloney]

Can you please provide me with more details on each treatment you had and pm me please asap? [e-mail]

I do not worry about hackers !!!!!

[TomMaloney in reply to billyboy3]

I went to the infusion room and they hung bags of jevtana and carbo.

I have prostate cancer in my liver along with tumors scattered everywhere.

My tumors have shrunk a lot and my PSA is 1.1.

[cesanon in reply to 1031Cancer]

I'd say he is more knowledgeable than most oncologists.

Maybe they are so busy practicing and sticking to soc, they don't have the time nor the motivation to keep current on the literature.

They just go to one conference a year and pick up any changes to soc. One and done. LoL

[Jewelrylady in reply to Tall_Allen]

did they ever start a phase 3 trial?

[Tall_Allen in reply to Jewelrylady]

IDK

[God_Loves_Me]

Please talk to doctor and find out what are best options for him. Here are questions that I would ask doctor

- Any clinical trials that available for him ?

- Agree with Tall_Allen as well. It solid advice.

- Any chance to debulking surgery and remove as much as tumor from the body

- Anything radiate the local spot and continue pluvicto ?

[Tall_Allen in reply to God_Loves_Me]

Sorry to interrupt but I saw your response - what research data makes you think that debulking or radiation is a good idea, or is that just your personal feeling?

[God_Loves_Me in reply to Tall_Allen]

I am sorry I was reading online a couple of months ago. I do not have an accurate reference link in my hands.

my understanding is many times, pluvicto or chemo do not shrink/kill the tumors in certain scenarios, and debulking can reduce the risk and give us time to find better treatment.

[Tall_Allen in reply to God_Loves_Me]

Your understanding is incorrect. The data prove otherwise:

prostatecancer.news/2018/09...

When more than 3 metastases are detected when one is originally diagnosed, there is no point in debulking the prostate. No one thinks there is any point in met-directed radiation, other than pain palliation, if there have been multiple metastases.

[God_Loves_Me in reply to Tall_Allen]

Thank you for explanations. I agree with you.

[1031Cancer in reply to Tall_Allen]

This is what he was told at the beginning of his treatments. He was not a candidate because of the number of mets.

[cesanon in reply to Tall_Allen]

I had 5 Mets. The radiation seemed to work. Though admittedly that could be confirmation bias.

[Tall_Allen in reply to cesanon]

How would you possibly know that "The radiation seemed to work."

[God_Loves_Me in reply to Tall_Allen]

Learning questions : Here example of debulking surgery. Here is the reference I am talking

healthunlocked.com/advanced...

[Tall_Allen in reply to God_Loves_Me]

I don't see a trial report at that link. There is a clinical trial that is ongoing to see if surgery is as good as radiation for debullking.

[Hidden]

I had 9 rounds of jevtana….no nausea, no hair loss….along with Lupron it held me for over 4 years…..treatment one hour every 3 weeks….was going for 10 treatments but numbers got a little to low so we stopped at 9….,,,

[1031Cancer in reply to Hidden]

Thank you. I need to look into jevtana. I haven't heard of it until now. It's a crazy battle you all have to go through. Sounds like you are doing pretty well. Good luck with your treatments.

[dk73 in reply to 1031Cancer]

Jevtana is cabazitaxel

[Hidden in reply to 1031Cancer]

At the time I was told Jevtana was more expensive than other Chemos….But if you have any neuropathy in hands or feet then Medicare will cover…,I have neuropathy in my feet from an unrelated injury….So Medicare covered…,

[dk73]

my husband had 4 rounds of pluvicto. PSA & ALP numbers went up over 230. Scan showed major spread of bone mets, skull to femurs. He now is doing Cabazitaxel chemo w/ prednisone. After round 5, PSA was 49. He feels pretty good, does get fatigued but he’s been battling PC since diagnosis in 2016 and he’s 71 now. Onco ordered a years worth of chemo. They said he might switch to every 6 weeks instead of 3 if PSA goes way down. He has had all other treatments: taxotere two different years, surgery, radiation, zytega, Xtandi, pluvicto. I asked about radium 223 but they wanted to slow the spread as quick as can, thus Cabazitaxel. It seems to be working

[1031Cancer in reply to dk73]

Thank you dk73. Makes me feel a bit better. I've been looking at radium 223. My husband is very scared of chemo. Although he had Docetaxel and seemed to tolerate it fairly well. I hope your husband continues to do well. I like the fact his numbers are trending in the right direction.

[dk73]

so far this chemo has had very little side effects. No hair loss. Just fatigue as it compounds.

[Searcher2020]

my husband just finished his third and now last round of Pluvicto. PSA 77. He has the Brca2 gene mutation and he will be starting PARP inhibitor in two weeks, He had Lupron, radiation and 6 rounds of Docetaxil. He has bone mets only but too numerous to count. He still feels good and has no pain inspite of spots on every vertebrae as well as spots sprinkled everywhere. I don’t know what has helped and what hasn’t and to what degree. After PARP it’s immunotherapy and we are currently investigating neoantigen trials.

[j-o-h-n]

Mucho Victo info in histo.....

Good Luck, Good Health and Good Humor.

j-o-h-n

[robert570]

Same condition here. I had cabazitaxel (Jevtana) for 2 years almost, PSA started to rise, but slowly. Put me on Pluvicto and my PSA rose each time. I had 3 doses also and I made them stop. They tried cabazitaxel and carboplatin together and it didn't work. I have exhausted every treatment and now they are searching for a clinical trial. My PSA now stands at 231.