Anyone in Actinium-225 clinical trial?

[SeekingInformation1]

This is supposed to be similar to Pluvicto but fewer side effects. Looking for anyone with direct knowledge of the trial.

[Tall_Allen]

Many more side effects for the same ligand.

[TTJJ1 in reply to Tall_Allen]

TA,

Can you further explain.

Always appreciate your knowledge and information.

Thank YOU

[Tall_Allen in reply to TTJJ1]

There are two parts to most radiopharmaceuticals: the radioactive element and the ligand. For example, Pluvicto is generically called lutetium (Lu )177 vipivotide tetraxetan. Lu 177 is the radioactive element that destroys the cancer with beta rays. Vipivotide tetraxetan is the "ligand." This ligand is attracted a protein, PSMA, on the surface of the cancer cell.

Side effects due to radiopharmaceuticals are also caused by both parts. Actinium (Ac) 225 is an alpha-emitter. Alpha rays are much more destructive than beta rays. That's a good thing if all it's doing is killing cancer cells. But if it attacks healthy cells, it causes more side effects.

Many of the current trials of Ac 225 radiopharmaceuticals use more specific ligands to try to avoid side effects. Healthy tissue damaged by PSMA-attacking radiopharmaceuticals include salivary glands, tear ducts, and the kidneys.

[TTJJ1 in reply to Tall_Allen]

TA,

I must first say that you are an incredible person and unmatched asset to HealthUnlocked - I always look forward to your input above all others and rely on your wealth of knowledge.

I went through 5 rounds of Pluvicto at Dana Faber over a year ago and had a 98% reduction in PSA, but eventually began to rise. After another PSMA-PET two hot spots (skull and scapula) SBRT treatment about 7 months ago. They are now waiting for final approval for an Actinium 225 trial and are hoping recruitment will begin in January. My MO has also scheduled a 6th round of Pluvicto in January as a back up if the AC 225 trial is further delayed. I am still on Nubeqa and Lupron. There is some concern that another round of Pluvicto may exclude me from the trial. I am trying to delay Cabazitaxel if at all possible - I am a full-time Judge and still very active (3 mile run each morning).

Any thoughts

Thank you for all your input it is appreciated beyond words.

[Tall_Allen in reply to TTJJ1]

Thanks for your kind words.

Do you know which trial of a Actinium 225 radiopharmaceutical you have applied for (there are several using different ligands)?

Unfortunately, Pluvicto, like all other prostate cancer medicines, eventually becomes resistant. Toxicity increases if uptake decreases.

[TTJJ1 in reply to Tall_Allen]

The trial ID is NCT0654965 / AC-225 Rosopatamab Tetraxetan

Thank you for following up with me, most appreciated.

Regards

[Tall_Allen in reply to TTJJ1]

Thanks- this seems to be the one:

clinicaltrials.gov/study/NC...

Because it uses a different ligand from Pluvicto, it is hoped that it will be more specific for metastases and therefore less toxic than if the Pluvicto ligand (vipivotide tetraxetan) were used with Ac225.

They also hope that it will kill cancer cells that your previous Pluvicto treatments missed.

I noticed that the inclusion criteria appropriately includes:

"PSMA PET-positive disease, defined as at least one PSMA-positive metastatic lesion and no PSMA-negative lesions."

My question is: how do they detect that there are no PMSA-nagative lesions?

[TTJJ1 in reply to Tall_Allen]

Way beyond me. I leave that to the experts like you.

Last PSMA-PET did show some PSMA positive disease. I assume the trial will require another PSMA-PET. Hopefully the trial will open up soon so I will not have to make the decision of another Pluvicto round and chance that it will disqualify me from the Ac 225 trial.

Once again, I cannot thank you enough for taking the time to respond to me. You are an amazing person for all that you do for so many . . .

Best Wishes

[gsun in reply to Tall_Allen]

The salivary glands are a problem. There is research going on now to hopefully fix this. Lu also causes problems but are usually reversible whereas Act can be permanent. The good thing about an aloe emitter is it has more destructive power to cancer cells and the Act destroys less healthy cells around the cancer. I’m looking forward to when Act is used like Lu is now.

[Tall_Allen in reply to gsun]

Hopefully, a more specific ligand than PSMA-617 will do less damage to salivary glands.

prostatecancer.news/2021/01...

[gsun in reply to Tall_Allen]

Thanks for that.

[NC_kid]

My dad was receiving Actinium 225 in a clinical trial with Dr. Nordquist in Omaha, NE. He was dropped from the trial last month after scans showed that he was receiving no benefit. He didn't have any issues with side effects other than dry mouth. He had received Pluvicto starting in August 2022 with very few side effects. He is now awaiting another trial and taking cabazitaxel every three weeks and he hates it. It has majorly messed with his taste and that has really bothered him.

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

Greetings NC_kid,

Sorry to hear about your Dad's issues, but I would like to ask you, would you please be kind enough to update his Bio. It will be helpful to him/you and us too. All info is voluntary. Thank you!!! Our best regards to your dear Dad (to you too and of course your family). You're a wonderful offspring and very special and loving to your Dad. Enjoy the Christmas Holidays,

Good Luck, Good Health and Good Humor.

j-o-h-n

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

I certainly will. I will get with my parents (mom is a RN, thank God) and update. Would I do that in my profile? I'm a long time lurker on this message board and have learned so much. Thank you!

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

Yes... and you're all fortunate to have a Registered Nurse in the family. Post often, we need you!!!

Good Luck, Good Health and Good Humor.

j-o-h-n

[SeekingInformation1 in reply to NC_kid]

I’m sorry to hear that the Actinium-225 didn’t work out for your dad. We are actually in the early stages of communicating with the same people in Omaha. Was the Pluvicto helpful to him in the past?