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Ac-225-PSMA-617 extends survival (update)

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Posted 12/22/2016 8:00 PM (GMT 0)
The nuclear medicine group at the University of Heidelberg are breaking new ground. Ac-225-PSMA-617 is an alpha emitter like Xofigo, but unlike Xofigo, it has the ability to kill metastatic cells systemically and not just bone metastases. So far, 80 patients have been treated and they have lived longer than expected with 3/4 of them achieving reduction in size of metastases and PSA.

With the euro at parity with dollar, this would be a good time for medical tourism. Contact details at the following link:

/pcnrv.blogspot.com/2016/12/ac-225-psma-617-extends-survival-update.html
Posted 12/22/2016 8:26 PM (GMT 0)
WOW. This is highly interesting -- a heckuva lot more interesting than those txs that are great with rats!

Very exciting -- but obviously many more trials are needed.

Allen -- if this is as good as suggested, how long would it take to become approved, a reality?
Would it be put on some fast track?

I figure 5 years?

Anyway, I am clearly overly excited here. But it sounds so promising

Mel
Posted 12/22/2016 8:55 PM (GMT 0)
Mel,

in your case - one lymph node met - a LU177 therapy would be the right therapy, provided you want a PSMA therapy at all instead of SBRT. LU177 will cause very few side effects, mostly none, while Ac-255 is a stronger emitter that will not allow you to get away without side effects.

In the article it says: "Prior to the treatment, their life expectancy was of 2-4 months." So this AC-225 is currently used if there are a lot of mets and usually after the patient had several chemos already.

George
Posted 12/22/2016 9:45 PM (GMT 0)
Mel,

They only report 24 week f/u results so far, and that's not even published yet. The FDA doesn't require that clinical trials be performed in the US, just proof of efficacy and safety. That almost always means a randomized clinical trial, but under the new FDA rules signed into law last week, they may be able to accept lower quality evidence in some cases.

So far, all of the trials of nuclear medicine have been in very advanced cases (distant mets and castration resistance (mCRPC), symptomatic, and often after all other therapies have been exhausted). (There's an ongoing trial among castration-resistant men without detectable mets for Lu-177-PSMA-617). Because of the advanced disease, it doesn't take all that long to prove efficacy - usually they stop it when the control group reaches median survival (which in this case would have been 2-4 months).

Like most new therapies, they test it first among men with symptomatic mCRPC. After they get approval for that indication, they see if it still works on less advanced cases, and those take longer to prove. The other major delay is manufacturing an adequate supply of the PSMA-617 ligand. The alpha-emitter, Ac-225, must be produced in a cyclotron from relatively rare radionuclides, like Ra-226, Th-229, or separation from nuclear reactor waste. This is tightly controlled, as you might imagine. The Idaho National Laboratory is producing supplies now, but it is part of the Dept. of Energy, which the incoming Secretary of Energy, Rick Perry, has threatened to close down. So it's anyone's guess whether it will be possible in the future in the US.
Posted 12/23/2016 5:23 AM (GMT 0)
Pretty sad to see that a (word deleted) (my opinion) will be in charge of a very important Agency (Energy) and yes he has indeed threatened to shut it down in the past.
Lesson here folks is that "elections have consequences" whether for the good or bad.
Don't want to inject politics here but when it affects our lives and medical research we need to be well informed.
Let's not forget GW Bush not allowing fed funding for stem cell research in the early 2000's which set back that type of research, which is now saving lives, many years back.
Here's the bottom line. If our Gov leaders stifle funding and research for political reasons in the USA, it will simply be funded in another country like Germany, UK etc. and we will be left behind in the dust.

Food for thought

(Facts not flames, please. Jim)

Post Edited By Moderator (Tudpock18) : 12/22/2016 10:31:45 PM (GMT-7)

Posted 12/23/2016 9:17 AM (GMT 0)
On the same subject. Impressive.

https://ec.europa.eu/jrc/en/news/prostate-cancer-alpha-therapy-shows-impressive-results
Posted 12/23/2016 9:54 AM (GMT 0)
Jim,

a cut back in funding medical research would also affect patients outside the US since these are treated based on this research as well.

George

Post Edited (George_) : 12/23/2016 5:07:38 AM (GMT-7)

Posted 12/23/2016 12:31 PM (GMT 0)
Mel,

the side effects of an alpha emitter like Ac-225-PSMA-617 are usually a dry mouth since the salivary glands get a hit. But they recover if the treatment is not repeated often. Also the bowel may be affected especially if it got damaged before from other types of radiation.

The images are impressive but these patients are so advanced that they have lots of micrometastases which will grow to a visible size soon. Then you have to repeat the treatment.

I think the LU177 treatment could be more effective if used earlier. Instead of adding Docetaxel at the start of an ADT you could start ADT and have an LU177 PSMA treatment as well.

George
Posted 12/23/2016 3:38 PM (GMT 0)
George:

For me, personally, with one hot node, I will do SBRT, if anything.
The new tx. works great for those with more mets. I agree with you that it probably will work great earlier.

In fact, anything that pushes chemo further down in the tx. choices is fabulous!

If SBRT does delay things and I can do the wack a mole, then that would buy me time. In time, more phase 2/3 clinical trials will occur and we will learn more.

Mel
Posted 12/23/2016 8:47 PM (GMT 0)
Well, starting with a methastatic prostate cancer already treated with ht and maybe two lines of chemo and others that is de facto with not other great therapy to keep it under control for which yuo manage to get undetectable PSA and good condition affer 15 months seems even to good to be true. results for other good experimental therapies in such condition scored 4/6 months more of life ... i'm thinking tonthe state of the art of last line therapies few years ago .. zytiga,xtandi, xofigo.
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