lutetium 177

Can't see a Lutetium trial listed by Cancer Research UK where current trials are usually recorded but it seems it is  now being administered (rather than just the pre requisite PSMA scan)  at Wellington Hospital in London.   Previously we had a couple of men who had it abroad. You might like to plough your way through this thread. https://community.prostatecanceruk.org/posts/t27445-Lutetium-177-treatment

Edited by member 27 Oct 2021 at 23:53  | Reason: to highlight link

Hi,

As I said on my previous posting Guys hospital hoping to offer L177 later this year but not yet NIce approved for NHS treatment generally.Perhaps others on this site can confirm this is still correct?

In the interim there may be trials going on that your other half may be eligible for ?Worth checking before paying out big bucks for private treatment.

Regards

Norm

Edited by member 09 Jan 2022 at 15:34  | Reason: typos

Costs in Germany seem to have increased. If not accepted into the UK trial which seems to start this June and is not certain you will get the 177 Lut arm anyway, you could get a quote from the London Clinic. https://www.thelondonclinic.co.uk/treatments/lutetium-177-psma-for-advanced-prostate-cancer

Edited by member 10 Jan 2022 at 01:45  | Reason: to highlight link

I have read it can make things worse and important all right scans are done

https://www.prostatecancer.news/2019/12/why-lutetium-177-psma-treatment.html?m=1

Does he have any genetic defect? Thinking parp inhibitor trials could be worth asking about too

Edited by member 10 Jan 2022 at 15:45  | Reason: Not specified

I’m not an expert by any means  (zero experience of clinical trials in fact) but yes it looks like it’s randomised but with some form of crossover option. I think you’d have to ask your oncologist to interpret i’m afraid

Hope that helps

Generally, cancer cells from the prostate express the prostate-specific membrane antigen (PSMA) protein on the cell surface. This membrane antigen serves as a target for certain peptides, so-called PSMA ligands (PSMA-DKFZ-617), which can be radiolabeled with therapeutic radioisotopes like the beta emitter Lu-177 (Lu-177-PSMA-DKFZ-617) or the alpha emitter Ac225 to deliver high dose targeted radiation to the tumour sites. This process is called radioligand therapy (RLT)

The therapeutic molecule is administered intravenously. It specifically seeks out and binds to the PSMA receptors on the tumor cells, and emits local radiation which leads to targeted irradiation of the malignant cells, leading to the cell death. Since the molecule only binds to the tumour cells and since the penetration of the radioactive particles in tissue is only a fraction of a millimeter, the normal tissue around the tumour cells is not damaged, hence this therapy is often called magic bullet therapy.

Various clinical studies show that RLT reduces tumor growth or substantially decreases tumor volume in the majority of cases. The therapy can also reduce pain and PSA values and improve the QOL.

Typically 3 - 4 doses of lu177 PSMA therapy are administered at intervals of 8 weeks. The injection itself takes about 10 minutes to administer. Dr hydrate the patient intravenously and the entire procedure can be done as a daycare short admission procedure.

Dr [Name removed by moderator] clinic sourced their non-carrier added lu177 from ITM Germany which is approved by both the European and Indian pharmacopia.

Lu177 PSMA therapy is very well tolerated. There may be some fatigue in the immediate post-infusion period. Some patients complain of some nausea and loss of appetite for the first week or so after the injection. There may be some lowering of the red blood cells after a few weeks but the lowering is usually not substantial to need any definite therapy. It usually reverses by itself. The principal adverse effect is xerostomia or dry mouth. Usually, the dry mouth increases with consecutive doses, and some of it is irreversible. There is usually about a 5- 10 % reduction in salivary gland function.

Lu 177 PSMA Therapy is effective in producing a reduction in the tumor sizes and consequently a reduction in PSA levels in about 75 - 80% of patients. The duration of response is usually about 1 year, however, there are a substantial number of patients who tend to remain in good response for longer.

Each dose of lu177 PSMA therapy costs roughly around 6500 USD in India. This includes the cost of hospitalization, medicine costs, consults, and the interim PSMA PET CT scans. etc. For more information, you can see my bio.

Regards Abhishek

Edited by moderator 28 Mar 2022 at 13:25  | Reason: Not specified

Hello Abhishek

I would like to sincerely thank you. I contacted Fortis Medical Centre in India on Tuesday and we had a video call with Dr [Name removed by moderator] on Wednesday. She was extremely helpful and the consultation has given us more hope. We are also in discussions with the Royal Marsden Hospital but in essence trying to be proactive about what treatment next. Husband age 55 is now 18 months since diagnosis and on cabazitaxel, having already been on abiraterone and doxetacle (which failed). Worried his treatment options are running out faster than we expected so we really appreciate all the helpful advice and signposting from this site and people on the forum. 👍❤️. Thank you 

Edited by moderator 28 Mar 2022 at 13:24  | Reason: Not specified

Hello Matthew2022 

Such heartfelt and kind words, thank you. 

I am so so sorry to hear you have this awful disease too. I hope you and your family are doing as well as you can and have a lot of support around you. In all honesty we were utterly grief-stricken for months and my heart felt broken. I couldn't work for months, I just needed to stop, be with OH and reset life priorities, which included me changing my job so we can spend much more time together. We both cried for a long time. My OH had no normal symptoms either. At the time he had developed a sore back (6 weeks before diagnosis).. His psa had reached over 900. Thankfully his first line of treatment (Abiraterone) was brilliant. It took about 3 months to adjust to the hot flushes and side effects but they soon settled, he even managed to get back to some cycling although a fraction of the distances he normly did. He still gets his monthly degralix injection, this will be lifelong. The side effects of this can be rough but usually doesn't last more than a day. They can give him headaches and cause sudden emotional periods. We've cracked it now though. He gets the injection around 6pm and goes to bed early so the worst of the effects occur when he is asleep. 

Unfortunately he is BRAC negative. If you get this test and are positive there are more treatments available. 

When Oh was diagnosed we were told his treatment path would be :Abiraterone, Doxetacle, Cabazitaxel, radium233 and possibly Lutetium 177 further down the line. 

Dr suggested Lutetium next. We discussed actinium 225 with her but we'd have to go to India for that and pay for it privately.

We should find out on Tuesday if the first dose of cabazitaxel is working. OH found the docetaxel side effects awful for about 10 days. Interestingly there's far less side effects with the cabazitaxel. 

We've also approached the Royal Marsden in London. We had a consultation with them 2 weeks ago. They are arranging  private testing on the dna of his tumour. He has an aggressive cancer so this is to see if there are any other mutations that other treatments may be available to treat. His biopsy sample will be sent to America for analysis. It may be a slim chance and long shot but there's no way we would pass this up. The Marsden is also referring him to the Beatson cancer Centre in Glasgow in the hope a clinical trial will become available.

I'm glad you are symptom free and hope that remains the case for a long time to come. Thinking of you and your family. I know it's very difficult to think of anything else right now but it will get better. 

Take care for now. X

Edited by moderator 28 Mar 2022 at 00:07  | Reason: Doctors name removed

Indeed Matthew, we share your thoughts and sentiments. 18 months on and despite monthly blood tests and the array of appointments we still find it all surreal, as though we are talking about someone else. 

Sending thoughts and positivity your way. X