Running out of Options

[deano58]

Hi Fellas

I’m now almost 19 years since original dx and almost 11 years Stage 4.

At the moment going through second chemo campaign, but there is disease progression.

There is only one clinical trial I meet the criteria for which I hope to start in May after my last chemo. Lutetium 177 would probably be of benefit to me, but even though the Australian Government will cover a large percentage of the cost after 1st July 2025, there seems to be hold up with when it will become available.

I’m in a bit of a dark place at the moment. I’ve always tried to be positive, but things are going a bit down hill for me now. As well as the prostate tumour which is growing into my bladder, I have multiple enlarged lymph nodes and a metastasis on my Spleen, which isn’t responding to chemo. Apparently this rare for Pca ?!

Does anybody know about the availability of Lutetium? Anyone else in a similar situation?

I would appreciate any feedback.

Thanks

[lcfcpolo]

Hi. I'm in the UK but one of the posters here had a really good response to J591, a Actinium. You Aussie's appear to be the leaders on this. I think he went to Perth and saw Nat Lenzo but when I looked it was available in Sydney. On the 24th April there is a online presentation title Unraveling PSMA biology. It's from Melbourne and about PSMA Theranostics. These are potentially the next version on Pluvicto. Has to be worth registering for. Let me know if your struggling to find anything on these 2 suggestions.

[PSAed in reply to lcfcpolo]

Well done Icfcpolo.

[deano58 in reply to lcfcpolo]

Thank you Icfcpolo

[Kimsark01]

Dear Dean, My husband has been metastatic for 14 years now and is not a candidate for Lu177, even though we've tried everything to get it. . We are also 67. You need to go to Austria and see Markus Hartenbach at Minute Medical in Vienna. We've talked to many with same scenario as you, who have had great success with LU177. We are headed there next week, actually for a 4th treatment. Dr. Hartenbach is a great guy, very smart and knows what he's doing. The patients we've seen before and after each of our treatments, all are doing well . My husband actually has a lymph node that is resistant so we're going there to try something else. I can give you the email if you're interested. Keep your chin up. There's alot of new things coming down the pike😀 We just can't get them here in the United States until we've exhaused every drug and chemo fails. And we don't have that kind of time. Blessings to you.

[j-o-h-n in reply to Kimsark01]

Greetings Kimsark01,

Would you please be kind enough to update your dear Husband's bio. Thank you!!!

Good Luck, Good Health and Good Humor.

j-o-h-n

[Kimsark01 in reply to j-o-h-n]

In 2011 age 53 diagnosed with stage 4 metastatic pc Gleason 8 10/10 biopsies positive. Completed 43 rounds of radiation and started ADT drugs. Cancer has not spread other than sometimes on scans l.ymph nodes in pelvic area show uptake, but not always. He gets very frustrated with this. He is on ORGOVYX, and has been for quite a while and is not tolerating it very well. It's been the worst one for him. We're headed to Austria for Terbium treatment. It is not available in the United States, but having good results in other countries. I'll be sure to let you know. Take care. God's in control.

[j-o-h-n in reply to Kimsark01]

Hello Kimsark01,

Quoting you "Your dear husband is on ORGOVYX, and has been for quite a while and is not tolerating it very well.

I know the feeling..... he is now 67 years old and has been fighting the beast for 14 years....I've been fighting the beast for 23 years and am 88 years old. Remind him that "birds of a feather........"

The following info is for the group.

Terbium-161,<===<<<

a Promising New Theranostic Radionuclide

Chun Kit Ho and Mohinderpal Kaur

Journal of Nuclear Medicine June 2024, 65 (supplement 2) 2430;

ArticleInfo & Metrics

Abstract

2430

Introduction: Peptide receptor radionuclide therapy (PRRT) has recently risen to popularity as a method of cancer treatment. Prostate-specific membrane antigen (PSMA) and somatostatin receptors (SSTRs) have been shown to be effective targets for radionuclide therapy. Terbium-161 (161Tb) is similar to Lutetium-177 (177Lu) in its half-life and decay processes, which include β ̄-particles and γ-ray emission. In comparison, 161Tb is a more effective therapy agent than 177Lu because of its substantial emission of conversion and Auger electrons.

Multiple ongoing clinical trials are investigating the safety and efficacy of medicines involving 161Tb. A Phase I clinical trial aims to establish the safety profile, dosimetry, and maximum tolerated dose (MTD) of 161Tb-PSMA-I&T in patients with metastatic castration-resistant prostate cancer (mCRPC). Phase II examines the effectiveness of the radiopharmaceutical at the MTD and gathers evidence of therapeutic advantages in targeted patient groups.

Methods: The synthesizing process and quality control of 161Tb-DOTATOC are completely automated. Automation streamlines the manufacturing process, lowers radiation exposure, and facilitates clinical translation. The production process takes 45 minutes and has the capability to generate a dose comparable to 177Lu-DOTATOC with 98% radiochemical purity.

Results: When evaluating a circulating tumor cell (CTC) derived from a prostate cancer patient averaging the size of 7.97 µm, 161Tb delivers approximately 3.5 times higher radiation dosage to the cell, while emitting radiation that is equivalent to that of larger cells.

When 161Tb is compounded with DOTATOC, it shows the same biodistribution as 177Lu-DOTATOC. The selectivity for subtype 2 (SSTR2) is retained and is comparable to 177Lu.

161Tb has the potential for PSMA targeted radionuclide therapy in prostate cancer through specific absorption of the radioligand at the tumor, resembling the uptake pattern observed with 177Lu-PSMA-617. 161Tb exhibited 1.3 times higher absorption compared to 177Lu. The efficacy of 161Tb induced cancer cell death was superior. Increasing the dosage of 161Tb by two-fold led to a decrease in the median survival time, indicating a direct relationship between the dosage and survival duration. Tumor-targeting agents labeled with 161Tb effectively delayed tumor growth.

Conclusions: Comparative studies demonstrate 161Tb's greater radiation dose delivery and effectiveness, particularly in smaller tumor spheres and circulating tumor cells. In comparison to 177Lu SST and PSMA analogs, 161Tb demonstrates matching biodistribution with comparable selectivity. The preclinical results for 161Tb demonstrate significant potential for improving treatment options. Leveraging preclinical data and innovative trial designs, 161Tb is a promising new theranostic radionuclide.

Good Luck, Good Health and Good Humor.

j-o-h-n

[FRTHBST in reply to Kimsark01]

Are you participating in a trial? Or is Terbium in clinical use in Austria?

[deano58 in reply to Kimsark01]

Thank you Kimsark01.

[Steel67]

reach out to Nat Lenzo is Brisbane - if your disease is PSMA avid - he has terbium for compassionate use - much better than Lu and easier to manufacture - good luck Dean