pluvicto and assisted living

[Pluvic123]

My father is 87 and due to start Pluvicto after doxcetaxel and cabazitaxel. Other than being fatigued and weak from 2.5 years of treatment he is in good health but still requires daily assistance to make sure he doesn’t fall; catheter changes, and dressing. My siblings and I wonder whether someone in his situation who should do Pluvicto.

[MWPesaPharmD]

The choice to treat, and with what/when, is best discussed between the patient, caregivers, and the medical team, that being said -- I can suggest a few items for discussion;

1) Pluvicto does require patients to increase fluid intake and to urinate frequently in order to clear the excess radiation from the body post-treatment -- will that be an issue?

2) There are certain distancing requirements post-treatment -- is the assisting living facility equipped and able to comply with those? (Or are his children able to?)

3) If your father wants to continue active treatments (and is not genetically eligible for something like a PARP-inhibitor) -- there are very few options remaining after Doce/Cabaz

--- The up-shot being that if he was able to make it through both of those chemotherapies, he sounds like one tough cookie to begin with, but when they were received and how he has done since then will come into play trying to predict how well he may tolerate Pluvicto

Best of luck with coming to the best decision for your father, whatever that may be

[jersy]

Hello. I recommend that you read the info on Pluvicto very, very carefully before proceeding, particularly the study results that led to the approval of the drug. The studies showed life extension of only 4 months (and it is questionable if your father even gets that much at his advanced age and with all his prior treatments).

The Pluvicto treatment is difficult in that it requires isolation during and afterwards due to radiation and as another writer points out, will that even be possible in assisted living? For me it caused crushing fatigue, and at 87 I think you have to think about increased risk of falls. I also had a severe effect on my salivary glands which destroyed my enjoyment of food - one of the few remaining pleasures I had, and I believe caused me to lose some teeth. The treatment started a downward cascade from which I did not ever recover.

If your father has decent quality of life, the risk is that he will destroy the time he has left by chasing an extra few months, and they may not be good months.

If it were my father I would try and enjoy the time left with him and try and keep him as comfortable as possible.

[EdBar]

My MO Dr. Sartor, one of the authors of the trial that lead to the approval of Pluvicto by the FDA said to me that 1/3 of the guys who use it get great results, 1/3 get an ok response and 1/3 get no response, just sharing this so you can factor it in to your decision. It is not without side effects and there are other factors to consider as well that other respondents have mentioned. In the end it is your dad’s decision whether or not to take on another difficult treatment.

Ed

[Miccoman]

As one of the 1/3 of the guys who had Pluvicto and had great results, I think it is worth looking at closely. If he has no response after 3 treatments you just stop. But the daily assistance is a problem.

I had minor saliva issues, not nearly as bad a chemo on taste and they have subsided. My QOL is much better and I'm looking at clinical trials now as my PSA slowly rises -- saving treatments we know will work for when I get really sick again.

The isolation requirements are not awful, but might be a challenge in the daily assistance -- there is a 3 day requirement to stay 3 feet away from people. I'm sure the catheter change can be scheduled around that but can he be mostly in a wheelchair for those days so the fall risk is avoided? Also there would have to be special attention paid to the disposal of his urine for those days, as well as the bags and catheter, probably.

The next two weeks of staying away from pregnant women, children and small animals probably is not much of a problem.

I'm only 75 and have been doing well with metastatic PC for 10 years so, of course your dad may react entirely differently.

I would also encourage you to get DNA testing of the cancer, if you haven't already, to determine if there is a specific treatment available there.

And remember, whatever decision you make it the right one for you. Do not second guess yourselves, but live on with the knowledge that you did the right thing at the right time. Remember the words of Bob Marley, "Don't worry, be happy" because being happy makes you feel good.

Looking back only creates stress and grief over woulda, coulda, shoulda and none of that matters, it only makes everyone feel worse and doesn't change a thing.

[speranza10]

You didn't mention Zytiga and Xandi, I'm guessing you've tried both of them, right?

[Pluvic123 in reply to speranza10]

They went straight to docetaxel and then cabazitaxel with my Dad.

[speranza10 in reply to Pluvic123]

But why didn't they try abiraterone or enzalutamide?

[Pluvic123 in reply to speranza10]

Not sure-started treatment at Duke University and now at Inova Fairfax. Tolerated both well and now it’s been about 5 months since last cabazitaxel.

[swwags]

My to cents. Wow 87. I'm impressed. I hope he's thinking it's been a life well lived so far and wish him many more years if that's what he wants. Is that what he wants?

[j-o-h-n]

Please fill in you Dear Dad's bio. All info is voluntary but it helps him/you and helps us too. Thank you and give him our regards.

Good Luck, Good Health and Good Humor.

j-o-h-n