Post - LU-177/Pluvicto

While I have had AMAZING success with my six LU-177/Pluvicto treatments last year (9/15/21 - 3/25/22) where PSA went from 65 to 0.64 this past June, I'm seeing a pretty nasty increase in PSA. Last month, it went from 2.01 to 4.8--largest increase I've ever had.

So, now I begin yet another journey, documented with this thread, with the hopes of doing a second series of Pluvicto. I'll report more in the near future. The roller coaster continues... All the best to my brothers and sisters. Steve

So sorry to read that your PSA is rising again.

I hate to bring this up, but my limited (!) understanding of any PSMA directed therapy is that metastases may consist of cells strongly expressing PSMA and others that don't. The latter will not be killed by Pluvicto and may (in due time) give rise to a population that is (way) less sensitive to this agent. If this is what is happening in this case, another therapy may offer a more positive outlook. Another round of chemo (cabazitaxel perhaps)?

Best wishes finding the next best step.

Hello, Steve55777 ~

I have been thinking of you. You are a compadre and trailblazer here!

I remember when you first embarked on your series of PLUVICTO treatments (Lutetium-177), there was the possibility of future treatments.

I found that to be such a hopeful possibility.

When I pursued TAXOTERE chemotherapy infusions, my oncologist stated future rounds were possible, down the road.

At that time, PLUVICTO was still in clinical trials. Now, it's a reality.

Just wondering ~ is it possible things like XTANDI or ZYTIGA can be prescribed now ~ before the next round of PLUVICTO?

What WOULD a round of chemotherapy do for you, at this point ~ with the idea PLUVICTO treatments could be held in reserve for the future?

These were just thoughts I was mulling over ...

Is your medical team recommending a second series of PLUVICTO as the next line of defense?

You have always followed a proactive & well-researched treatment plan.

Is there a timeline in mind for a second round of PLUVICTO treatments?

Above all else, I am sending you my thoughts of support.

I will continue to watch for your future posts, Steve55777!

In fellowship, from "one brother to another" ~

CYCLONE ~ # Iowa State University

Thanks all. As for Sr comments, I'm pretty sure that most of the "PC that I had last year" was killed or otherwise subdued by the LU-177 and that there wasn't much remaining after my last LU-177 treatments, given my PSA = 0.64. So what's coming back quickly may just be the stem cells of the PC that was affected/killed off by the LU-177 treatments.
Will be heading back to UCLA for another PSMA scan, likely in January. Trying to line up additional Pluvicto treatment options for after that. Will keep you updated. THANKS for the continued support, brothers.

Thanks for checking in , CYCLONE. Always appreciate your comments, concerns and dedication to the brothers of this forum.
Always easier to give the good news--like I did while my PSA plummeted from 65 to 0.64. Now, however, the PSA is going up--and fast. My PSA began it's climb last July (0.74) to it's current level of 22.88. I'm finding that it may be difficult for me to get another round of Pluvicto (LU-177) due to supply -- and that I've already had it.

I'm looking into a trial for something called Actinium, a LU-177 cousin of sorts, from Houston, TX. Costs $13,500 per treatment because there's no drug co sponsor... May head to Germany or Australia if that's not possible.

Will have a PSMA scan at UCLA in a couple weeks to survey the situation. Hoping for a big spot somewhere that can be radiated. If not, maybe Xofigo or the dreaded chemo with Jevtana. Also, if there's a big spot, doing a biopsy of that and another Guardant 360 test.

Thanks, brothers, for your support.

Hello, Steve55777 ~

You have blazed a new trail, in terms of new breakthrough treatments.

Your experience with Lutetium-177 was absolutely jaw-dropping, in terms of success.

I'm thankful you have timely scans in the near future. That may help pinpoint your next step.

Dr. Kwon at Mayo Clinic always emphasizes the importance of scans and imaging when I consult with him.

He will exclaim and emphatically state, "Imaging, imaging, IMAGING!"

Do you have a lead doctor, guiding your case?

If radiation is indicated, that can pay dividends. It certainly did for me.

I almost wonder if a round of chemotherapy infusions might pack a mighty wallop against the foe? That approach has been around for years.

Chemotherapy wasn't a walk in the park for me, but I DID feel it knocked out stubborn and resistant cancer cells, in my case.

I was really hoping that a second series of Lutetium-177 treatments might be a great plan for you. I'm sorry to hear that plan might be "jammed up" in terms of approval and product availability.

Is there a supply chain issue?

Is there a doctor that can find a "workaround" solution for another round of Lutetium-177? An appeal filed with insurance? Compassionate use clause? Just thinking & brainstorming aloud!

I hadn't heard about the "cousin" to Lutetium-177! That DOES sound promising!

You're staying right on top of everything. You are considering all avenues. You have not discounted any treatments. You are taking a proactive and forward-thinking approach.

We're a band of brothers here, and we're rallied around you, Steve55777.

Keep in touch with us here, and no one here fights alone.

A fellow compadre ~ standing alongside you ~
CYCLONE ~ # Iowa State University

Steve, my fingers are crossed that your next scan gives you great feedback to keep up the fight. Stay positive. My best to you,
Jack

Thanks SO much Cyclone. I have PSMA scan at UCLA Tuesday and will report in greater detail when I have the results. Will explore Prince trial today. Steve.

Steve,
Man, that's good hear! Sounds like you're stoked and will be blazing a new path for others to follow. I'm hoping for some great results for you!

Steve55777 said...
The doctor knows of no other patients who are receiving a second round of Pluvicto, but doesn't believe there would be problems, given a strong patient with proper blood counts. Especially important are Red/white counts, platelets and condition of liver/kidneys.

Great news!

Sometimes the first mouse does get the cheese.

Hello, Steve55777 ~

You might be hearing a CELEBRATORY cheer from across the miles ~ and that "ruckus" is from me ~ after I read your update.

I have been thinking of you, and reflecting on the awe-inspiring drop you experienced from the initial round of PLUVICTO treatments ~ Lutetium-177.

I remember, when all of this was so new, they had mentioned the possibility that additional rounds of treatments would perhaps be considered.

Similarly, when I was in the first wave of fellows who pursued the upfront "early chemo" treatments with TAXOTERE when those were first recommended, my doctors stated additional infusions could be given, down the road.

I'm REALLY thankful to hear this news. You have no idea how excited I was ~ reading that a second round of PLUVICTO can be given!

I think these treatments represent a new & revolutionary approach ~ different than radiation or chemotherapy ~ different than medications like XTANDI or ZYTIGA.

Your experiences are REALLY blazing a new trail.

There's a cadre of us fellows here who have pursued a variety of treatments, over time. PLUVICTO holds such promise and potential, as evidenced by your direct experiences!

We need to get to the point in the treatment landscape where there's a wider variety of options available ~ and where certain treatments can be used effectively multiple times ~ and combined with other treatments to provide synergistic effects in the battle we have all faced.

Let us know when treatments commence!

Was SO happy ~ reading the encouraging news in your update, Steve55777!

Handshake, camaraderie, & fellowship ~ from "one compadre to another" ~

CYCLONE ~ # Iowa State University

Thanks all for your kind thoughts and well-wishes. The news of a second round of Pluvicto is especially meaningful as my PSA went from 38 to 88 in the last month. Yes, you read that correctly. A few replies to the above comments:
1. The PSMA scan showed lots of new spots over the PSMA from a year before.
2. I've never had a biopsy--so we're going to pick a spot on bone to do a biopsy for possible "mutation therapy" down the road.
3. Two of my onco docs said another round of chemo (jevtana) should be next if I couldn't get Pluvicto. I had taxotere back in 2018. It's uncertain how effective jevtana would be at this point, though I know it would kick my ass as opposed to Pluvicto. I told docs I'm doing Pluvicto--whether I have to go out of the country or not.
4. It's true that some cancer can "escape" the Pluvicto. It's also true, as I 've said before, that for some, Pluvicto doesn't work effectively.
5. Unrelated - but I switched from Orgovyx back to Lupron shots. I swear there's no SE difference (for me) between the two. I went back to Lupron because it's a painless shot once a month instead of a daily pill, covered as a medical expense by Medicare, instead of a prescription for Medicare. Big $$$ difference.

Will keep you all posted. Thanks brothers and sisters, for all your support. Steve

Hello Steve55777 ~

Have been thinking of you, hoping you are doing your best.

I can understand why you switched back to LUPRON, in terms of insurance coverage.

Did you get your biopsy scheduled yet?

Hoping your pathway to the next series of PLUVICTO treatments is getting mapped out, without a hitch.

We're a "BAND OF BROTHERS" here. We're all standing beside you.

Wanted to let you know I have been thinking of you ~

CYCLONE ~ # Iowa State University