Second round of Pluvicto?

[wontrememberthis]

FIL has exhausted other options and did well on Pluvicto this year. PSAs started going up slow and steady after his sixth treatment of Pluvicto (still lower than where he started). Has anyone gotten approval for a second round of Pluvicto for six more treatments? His doc is saying that's not an option bc it's "too much radiation" but isn't that the lesser of two evils at this point?

[Tall_Allen]

Repeat radiation can seriously damage healthy tissues, especially bone marrow, and lead to death sooner. It can be the greater of two evils.

That said, there has been a retrospective studies of going as high as 10 cycles in good responders. For most, there was still some PSA response and toxicity was not critical:

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

There is also a danger that the PSMA-negative cancer that is left behind will accelerate its growth without competing PSMA-positive cancer:

prostatecancer.news/2019/12...

For this reason, it may be advantageous to alternate with a non-PSMA treatment, like cabazitaxel or Xofigo.

[God_Loves_Me in reply to Tall_Allen]

Learning question after pluvicto - can we do 177lu-tlx591 ?

[Tall_Allen in reply to God_Loves_Me]

Even the most specific ligand will expose healthy tissues to excess radiation. The beta rays of any PSMA-targeted Lu177 radiopharmaceutical can damage or destroy cells as far away as 2.5 mm or about 125 cells. This can damage bone marrow. In addition, it is excreted by the kidneys and can damage them.

[God_Loves_Me]

To answer your questions related to the Second round of Pluvicto,

I know 2 or 3 users in this group got insurance approval to do a second round of Pluvicto again. Even one user was doing the 9th dosage, and the doctor was monitoring the toxicity in a Facebook group called " Pluvicto Support Group."

I hope doctor can suggest good clinical trials rather than pluvicto or other FDA Drugs

[Cenerus]

He could also try applying to an Alpha therapy trial.

[wontrememberthis in reply to Cenerus]

Do you have any info on that study? We are based in MA.

[Yank66]

My husband had a remarkable response to the first six Pluvicto treatments. Insurance approved 3 more 10 months later. He was only able to complete 2 of the doses because of compromised bone marrow. He is now receiving transfusions weekly while receiving Keytruda. We’re hoping his bone marrow will begin producing again.

[OGSteelGuy]

There are a handful of clinical trials recruiting now for post-Pluvicto scenarios.

Ac225 is an alpha emitter which has a tighter radiation sphere, so it has less impact on healthy tissue.

* clinicaltrials.gov/study/NC...

(At a number of locations, but nothing in MA.)

* clinicaltrials.gov/study/NC...

(I'm told that this will be available at Dana Farber in Boston, but it isn't yet. It is a MA company FYI. )

* other trials in Europe etc...

A Pluvicto re-treatment trial is going on at UCLA, Los Angeles.

* clinicaltrials.gov/study/NC...

And a number of top locations Stanford, Mayo, Weill Cornell NYC are working on a Cu67 treatment. Seems to have some good early press, fwiw.

* clinicaltrials.gov/study/NC...

I go to Dana-Farber Boston and am in a similar situation... I'll be discussing these and other options with my Dr in a few weeks after a new psma scan.