My MO recently told me that there were no guidelines about which patients would most likely benefit from Pluvicto treatment. On this forum, a few weeks ago, someone mentioned a certain biological profile that seemed to linked to successful Pluvicto treatment.
Has there been any study on that?
I am NOT BRCA, but I am CHEK2 mutation, and my biopsy results also show PTEN-loss and TP-53 variant.
I never heard of any genomics that predict Pluvicto success. Here's a way to predict Pluvicto failure:
prostatecancer.news/2019/12...
I wonder if alpha emitters are more likely to work. Less range but higher dose? I just talked to my main oncologist, Dr. Aggarwal and he is now in agreement with me that Pluvicto has pretty much failed in spite of "technical success" as indicated by SPECT scan that shows uptake. But for some reason it did not work for me so Pluvicto is being terminated.
I agree that most likely reasons for failure are variability in PSMA expression from cell to cell and limited range of pluvicto. I doubt that anything genetic could alter the susceptibility of cells to damage by radiation.
Alpha emitters should be more effective than beta emitters like Pluvicto. Alpha particles create double strand breaks in DNA which is essentially impossible to repair. Beta emitters like lutecium and copper 67 only tend to create single DNA strand breaks which can be repaired by repair enzymes. Alpha emitters also travel very short distances of about a single cell diameter. This is great for destroying micro metastasis that aren’t yet detectable. So if these new Alpha emitters like Actinium and Astitine can get on the market, they have a chance to create more thorough and durable responses than drugs like Pluvicto.
Sounds promising...thanks!
Hi Allen...thanks...I appreciate the link. The information was somewhat overwhelming, and I don't think I can follow it well. I have been on Firmagon for 15 months, first combined with Zytiga (until my liver enzymes continually spiked), then with Casodex and now Xtandi...which seems to be failing. MO is talking about chemo and Pluvicto, it sounds like, from the report, Pluvicto might be better before doxetaxel? The report is 5 years old, is there any newer research?
The order of chemo and Pluvicto doesn't matter, but Pluvicto is only approved after chemo right now. Ask for an FDG PET scan in addition to the PSMA PET scan.
My most recent PSA score (after an IMRT treatment) was 0.15. The month prior it was about 0.42. I've read that the PSMA is only accurate when PSA is greater than 1.0-2.0. Is the FDG PET scan accurate at lower PSA? My consulting MO wants to order a bone scan, since PSA is so low, but pain in my pubic bone area is increasing. I'm not sure if it is wise to do palliative RT to my pubic bone and sits bones using just a bone scan, or if we need to wait until my PSA rises enough to get an accurate PSMA reading? I'm often in significant pain when sitting and especially driving, but the tumor growth (judged by the symptoms) is not reflected in my previous two PSMA scans due to low PSA. Thoughts?
0.5 is good enough for PSMA PET, much higher for a bone scan/CT. A CT may be able to detect the source of your pain. FDG +PSMA is only relevant for Pluvicto, not for what you are talking about.
Thanks...is a CT scan at PSA of 0.5 accurate enough to use for palliative radiation of bone mets? It sounds like your saying that the PSMA scan is a much better option at PSA 0.5-2.0 if I need RT to reduce pain caused by bone mets. I've had two PSMAs, both were taken after starting hormone therapy and with very low PSA. The original CT scan showed much more wide-spread disease, but that was taken prior to any treatment being initiated. I'm beginning to think the CT scan was more accurate than either PSMA scan?😟 Fortunately, my overall symptoms, excluding the previously mentioned pain, are still relatively minor.
CTs are always given together with PET scans. They have to be used to locate radiation.
Do CTs alone provide enough information for palliative radiation therapy, or is a PET scan required to insure accuracy? My new MO only ordered a CT bone scan but not a PSMA scan.
CT shows if there is a bone lesion, but it doesn't tell you why.
Thanks...I appreciate all of your help today! Have a blessed evening!
I don’t know of any, I also have CHEK-2 mutation and my oncologist, Dr Sartor never mentioned it. He did say that with Pluvicto 30% have a great response, 30% have an ok response and 30% have no response. It’s possible that a Parp inhibitor may help but I haven’t looked into it that deeply yet, the SE’s are pretty harsh.
Ed
Thanks Ed...my primary MO is thinking about trying PARP inhibitor oliparib (Lynparza), but I've also been told it would probably not be effective unless the patient has a BRCA mutation, which I don't.
I believe there are some Parp inhibitors that can be effective for ATM mutations and I believe CHEK2 falls into that category, you might want to check with your doctor
Ed
I will...thanks!
for us a PSMA scan and excellent bloodwork was our ticket for approval. But unfortunately after 4 treatments, his alkaline phosphate number, along with PSA, was over 230. A new scan showed major progression of bone Mets, skull to femurs. He returned to chemo, Jevtana this time
I have no actionable mutations and am 11 months post-Pluvicto. Had a great response but what's left is starting go increase dramatically in the last few months.
One of the benefits of getting CDs of all my imaging is that I can see, for myself (I have a old free DICOM viewer plus Photoshop), what's going on and not just rely on figuring out the "doctor talk" in the reports. Of course, I'm not trained in what I'm seeing, but on the overview level it can be quite interesting. Here's my year-over-year PET results.
Thanks Miccoman...glad to hear you had a good response, at least for awhile. Hopefully you can find something else that your body will respond to in a very positive way.
as Tall_Allen said, your best bet is to get an FGD PET as well as the PSMA pet. If there are spots that show up on FDG that don’t show up on PSMA, then pluvicto is very likely to fail, as you have non PSMA avid lesions.
For that reason, in australia, a PSMA vs FDG comparison is always used before pluvicto, to avoid wasting money on an expensive treatment likely to fail
Thanks Steve...I appreciate the succinct and useful response.
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