Lu-177 or Actinium 225

[Islandboy2021]

If you you had a choice between Lu-177 or Actinium 225 which one would you do. This is for advanced stage after chemotherapy has been exhausted.

[Tall_Allen]

Assuming you're talking about PSMA-directed radiopharmaceuticals, I would get an FDG as well as a PSMA PET scan. I would get a mixture of the two (available abroad) or a more specific Ac225-PSMA ligand (like J591, available in clinical trials).

[Islandboy2021 in reply to Tall_Allen]

I have had the PSMA scan already as I was pre-screened for a trial with Lu-177. The trial was cancelled the day before I was to start with the injection.

I am trying to get into a trial for Actinium-225-macropa-pelgifatamab. Would this be comparable to the Ac225-PSMA ligand like J591 that you mentioned?

[Tall_Allen in reply to Islandboy2021]

It sounds like it is a more specific antibody that the Ac225 is attached to. J591 is called a "minibody." The reason for a more specific attachment is xerostomia, discussed here:

prostatecancer.news/2021/01...

[RyderLake2]

Hello,

We have corresponded…many times. Targeted alpha therapy shreds the DNA of cancer cells by using radioactive alpha particles. These are more powerful at killing cancerous tumours and less damaging to healthy tissue. Dr. Bénard of the BCCA puts it this way: Existing radiopharmaceutical treatments that emit beta particles like Lutetium is akin to throwing a golf ball inside a glass house. It can travel quite a long distance and cause various bits of damage along the way.

In contrast, targeted alpha therapy e.g. Actinium is like throwing a bowling ball. It causes a lot more damage, but in a much more limited area. I don’t think Actinium is approved yet in Canada but if you can get it through a clinical trial then my recommendation is go for it. Good luck!

[Islandboy2021 in reply to RyderLake2]

I am working against the clock here. They have a trial for Actinium-225 in Vancouver and the Lu-177 is apparently going to be available here in BC in a couple of months.

My bone tumors are spreading and starting to invade my bone marrow. Becoming weaker and slightly anemic. Not sure if I can wait a couple more months.

[RyderLake2 in reply to Islandboy2021]

Hello,

They have a couple of trials currently involving Actinium at the B.C. Cancer Agency in Vancouver that are either recruiting or about to recruit. Can your Vancouver Island oncologist pull some strings to get you into one of these? From your reply, I am assuming you might be too weak to undergo an overseas flight to England, Germany, India, Australia or numerous other countries where Actinium is more of a mainstream treatment. Good Luck!

[God_Loves_Me]

I would go for TLX591 is an investigational anti-PSMA[1] radio-antibody-drug conjugate (rADC) therapy being developed for the treatment of mCRPC, differentiated by a short two-week dosing regimen

Source : telixpharma.com/news-views/...

[GP24]

Actinium often destroys the salivary glands and causes permanent dry mouth which is a very bad side effect. I would try Lutetium first. If this does not work you can try Actinium.

[pilot52 in reply to GP24]

I had a combo of AC225 + Lu-177 , They administered ultrasound guided botox to my salivary gland to reduce uptake. This procedure began in Germany...I had it done in Delhi...

[Swank64 in reply to pilot52]

Got my first Ac225 treatment, dry mouth symptoms are present. Did icing during treatment. Licking Lemons and sucking lousengers. Seems to be working? But very interested in Botox treatment, how long does it take for Botox to where off?

[Miccoman]

I was advised by an MO at Roswell Park Cancer Center to try and get into an Actinium trial, but was unsuccessful. He stated that the alpha radiation was more effective and he thought there were fewer side effects.

As for the salivary gland issue -- they present PSMA so no matter which way you go they will be affected if the ligand attaches to PSMA. I chewed ice chips during my Pluvicto sessions to keep my mouth wet and salivary glands as quiet as possible. Did it work? Who knows, but between Acupuncture and time, they are working ok now (they got pretty beat up from radiation and chemo before the Pluvicto).

If there were a way for me to get Actinium, I'd go for it but without that option I've decided to go for another round of Pluvicto and hope that next year I can get into a copper trial.

[Islandboy2021 in reply to Miccoman]

Do you think chewing on ice chips helped the salivary glands. Have you heard of any other precautions you could take to protect the salivary glands?

[TTJJ1 in reply to Islandboy2021]

I did 5 rounds of Pluvicto about 1 1/2 years ago, had great results. I did Ice chips each time but it did not help with salivary glands. Dry mouth and awful taste lasted about 8 months, but never back to normal. I was told by my MO that ice chips did not help most people who did ice chips, I recently had a 6th Pluvicto infusion and side effects immediately started again within a week. I am now awaiting word on Actinium 225, which I understand has less side effects. As you know, no real clear answer for everyone.

Best Wishes

[Miccoman in reply to Islandboy2021]

As you have found out, we are pretty much on our own to figure out how to deal/prevent side effects. I had read a lot about ice during chemo and did the ice chips then, too. Nurses said it was useless, but went along with it.

I figured if the theory that keeping areas cold to reduce blood flow and mouth wet to keep glands inactive could work for chemo, then it was worth a try during Pluvicto.

Did it prevent dry mouth. No. But again my mouth was a mess from previous treatments so I can't be sure what the effect was. I'll have a better idea if I get to do another round since my mouth is much better now.

[Islandboy2021]

You would think they could come up with something to protect the salivary glands. TA sent some information on this. There was a study that said they injected a saline solution into the salivary glands directly after the treatment and this seemed to work. Apparently it needed to be done right away. Not sure how you could get the clinical staff to do this for you. I hate to say this but it seems you are left to deal with the side effects from these treatments on your own.

[FRTHBST]

I had Actinium as the first radio-ligand treatment overseas. The doctor said that it would be more effective on bone metastes.

[SViking in reply to FRTHBST]

Well what was the outcome? Was it effective?

[FRTHBST in reply to SViking]

It was very effective. I had 3 treatments in 2023 one month apart. The first being actinium, the other two, LU-177. I was still hormone naive and needed to go overseas. My situation was fairly dire with metastases everywhere. After a failed immunotherapy, PSA had gone from 60 to 288 in a few months. PSA was down to 7 after the first treatment and was a low as .09 within 6 months. I was on Orgovyx during the treatment period. By June of 2024 PSA was back up to 35 and I had 3 more treatments late summer through Fall. PSAThe Dr. did not think I needed further treatment with actinium, so these were LU-177. PSA responded well again, dropping to 3. On 1/25 PSMA scan there were 2 areas that showed activity, one side of the prostate and a spot on one rib. The Dr. recommended Cyber Knife for these. then it got complicated when a biopsy of the prostate turned up a mix with neuroendocrine present. Getting a dotatate scan next week and hoping the neuroendocrine lights up. Overseas they use dotatate as a ligand for treatment of neuroendocrine Pca if it binds with it. Otherwise neuroendocrine doesn't typically produce PSA or register on any current scans. I thought I was doing great, but it's always something...