Will Lu-177-anti-PSMA be the next Xofigo?

Thanks for this info, it sounds promising. We realize we are in it for the long haul.

You are The Man!

2015 Society of Nuclear Medicine and Molecular Imaging "Image of the Year"

http://medicalxpress.com/news/2015-06-snmmi-image-year-theranostic-drug.html

Each year, SNMMI chooses an image that exemplifies the most promising advances in the field of nuclear medicine and molecular imaging. The state-of-the-art technologies captured in these images demonstrate the capacity to improve patient care by detecting disease, aiding diagnosis, improving clinical confidence and providing a means of selecting appropriate treatments.

The 2015 SNMMI Image of the Year goes to a team of researchers from the department of nuclear medicine at the University Hospital Heidelberg and the German Cancer Research Center in Heidelberg, Germany. The emerging technology portrays a theranostic drug called PSMA-617, a prostate-specific membrane antigen inhibitor that targets the enzyme on the surface of prostate cancer cells, even if they have spread, or metastasized, to other organs.

'We feel very honored to receive this prestigious award as it is the result of the excellent work of many people,' said Matthias Eder, Ph.D., co-author of the study and a researcher in the division of radiopharmaceutical chemistry at the German Cancer Research Center. 'I would like to thank all the team members who contributed to this work.'

For imaging, PSMA-617 can be radiolabeled with gallium-68 (Ga-68), and for therapy, lutetium-177 (Lu-177). Follow-up with PET/CT and Ga-68 PSMA-617 showed a substantial reduction in radiotracer uptake, which indicates a positive response to therapy. Researchers also found a major decrease in PSMA in the blood from 38.0 to 4.6 nanograms per milliliter.

'Prostate cancer remains one of the main causes of cancer-related death among men worldwide,' said Peter Herscovitch, 2014-15 SNMMI president. 'This new molecular imaging technology not only detects metastatic prostate cancer, but also can treat metastases non-invasively. It is the combined capability of diagnosis and therapy that makes this molecular theranostic so powerful.'

Rigby,
Because PSMA expression seems to be correlated with Gleason grade, it probably is not the magic bullet we are looking for for low and intermediate risk prostate cancers. However, for anyone originally diagnosed with GS 8-10, or with a recurrence, I think it is very promising. I'm telling guys in my support groups who have recurrences to go to Heidelberg. They are way advanced over anything currently available in the US in many aspects of diagnosis and treatment, and the lower cost of treatment there (and the favorable euro/dollar balance) may more than pay for the trip.
- Allen

Well, Scott Tagawa's study is scheduled for completion by December 2016. Assuming it shows a benefit in radiological progression, there will be an expanded Phase 3 trial for a couple of years after that before FDA approval - so about 5 years on fast track, I'm guessing.

Meanwhile, there may be US trials of other cancer-toxic entities attached to anti-PSMA. Things like alpha emitters (Ac225/Bi213), viruses, antibiotics, nanoparticles and chemo. At the same time, the PSMA antibody is already being refined, and prostate stem cell antigen (PSCA) antibodies have already begun clinical trials.

As you know, the PSMA-targeted diagnostics have been in clinical trials, and I expect those will eventually replace the C-11 PET scans.

- Allen

LOL@Heineken-177 (although it's Dutch)

I received email from someone who was treated there. I suggest you email Uwe Haberkorn there with your questions - he speaks English. I have his email if you need it. I don't think insurance will be useful there, but German prices are a lot lower than US prices (especially with the currently favorable exchange rates).

- Allen

Hi Jerry,
I have been treated in NY and Heidelberg as an international patient, so I can compare the cost of the treatments. Heidelberg is much much cheaper than the US. To give you an idea, 8 months ago I had a biopsy of the pelvic area, appointments with 3 doctors (all well known professors), various blood tests and reviews of previous scans, etc by experts...
The total cost was something like 2,700 Euros (approx 3000 USD).

Perhaps "Low Road" will chime in. He tells me that, perhaps better than Heidelberg, is the Central Clinic of Bad Berka. Professor Richard Baum there has treated 150 patients with Lu-177-PSMA and has the most experience with this treatment. It cost 4000€ ($4,500) for one treatment, and he knows someone who had 3 such treatments, 2 months apart. His PSA dropped from 50 to 24 two months after his first treatment last September. Two months after the second treatment, his PSA dropped to 15, and two months after his 3rd treatment, his PSA dropped to 7, and kept going down on its own to 4 so far this month. A PET scan showed significant regression of metastases. Very impressive!

- Allen