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Update Lutetium177 Trial. - Treatment for Castrate Resistant Prostate Cancer.


Barree

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Barree :-   Lutetium 177        Treatment - Complete and now behind me . 15.11.2016  Update

The final infusion of Lutetium177 was administered mid July 2016.

Subsequent scans show quite a few of my bone mets have reduced in size and intensity.  Blood tests show a falling PSA but bone pain level has not dropped significantly.

PSA at the commencement the trial was 85.6.

Blood tests in October show it to be 8.3. It seems that this will be the nadir unless some additional treatment is undertaken.

At present the only treatment I am receiving is a 10.8 mgm implant of Zolodex every 3 months.

 

Active surveillance is considered to be the appropriate course of action for the next 3 months, that is until a review is done of a comprehensive series of scans - scheduled for mid January 2017.

Results of these scans will determine what ongoing treatment program is most likely to be appropriate.

 

Up until 6 months ago testosterone level has been acceptably low but a test for DHT is overdue.

It’s probably time to instigate some tests myself to monitor what’s happening to PSA Testosterone and DHT.

Should my PSA level remains where it is at 8.3 my preferred treatment option will be to explore the feasibility of having another Lutetium177 infusion.

If this is not considered feasible, advisable or too risky, the scans should provide a reasonable indication as to what I should do next.

 

If an additional Lutetium177 treatment is not practical, maybe some sort of salvage radiation therapy might be possible – something like LDR Brachy.

However the practicability of this is totally dependent upon the location of the few remaining hot spots and accessibility. This information should be evident when the next Gallium68 PSMA scan results are reviewed.

Another major factor determining ongoing therapy will be examination of original radiation treatment levels and prior treatment locations to ensure that there is no likelihood of creating unwanted problems associated with excessive doses of radiation.


Fortunately these records are available and accessible and the original radiation treatment was done on an IMRT machine.

 

Bone Pain  I have given some thought to Radium 223 but indications to date are that not a lot of patients have found this to provide much relief.

The other things left to investigate are Xevga, Bisphosphonates and specialist pain management.

Ever Onward - the next trial treatment is still to be determined.

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alanbarlee

G'day Baree,

You probably have considered denosumab for maintaining cortical bone strength?

I recently ran into another candidate on the Peter Mac 177-Lu study (who knows you from the trial), who has had spectacular success in dropping his PSA down to undetectable with lutetium.

Keep your eye out for an immunotherapy trial (esp. pembrolizumab plus ipilimumab - possibly a bit toxic but giving good results with some men).

Good luck!

Alan 

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Hi Alan,

As always your considered opinions and suggestions are really appreciated.

Until I have the next lot of scans, I am loath to start on any new treatments but Xevga is definitely high on the list of possibilities.

Some patients, particularly a few that have been having concurrent treatment whilst on Lutetium have responded fantastically well.There is no doubt that Lutetium is some instances shows great prospects.

I have made enquires regarding the pembrolizumab plus ipilimumab and the up and coming Parp inhibitor trial but the principle investigators are a little slow in getting underway with recruiting. I am waiting patiently.

Cheers,

Barree

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DavidAbrahams

Hi Baree,

 

If you have bony mets in your spine, particularly your lower spine you should strongly consider having bisphosphonate treatment to prevent spinal compression. I presently have an Xgeva injection every 6wks (meant to be every 4wks) which is just a jab in the stomach via GP nurse. Prior to the Xgeva I was on Zometa which is an infusion, Hospital day patient and takes about 20 - 40' depending if you have side effects. Helps to strengthen and repair long bones in particular damaged by bony mets.

 

With respect to managing your bone pain I would recommend Fentanyl Patches. Has certainly helped to improve my quality of life. Unlikely that an Oncologist will agree for you to go down that path so you may have try your friendly GP of Pal Care Consultant. I had excruciating bone pain about 4yrs ago and the MO kept increasing the oral opiates to no avail. The Pal Care Consultant had the pain under control within about 6 - 8wks starting on a small doe and working up. I am now on 75mcg/hr and very occasionally have take a break through tablet. (Oxy norm 20mg)

All the best David (ps Call if you want to chat.)

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Hi David,

Many Thanks for your suggestions regarding the options for bone met treatments

A jab of Xgeva would certainly be more convenient than an infusion of Zometa.

 

I have been on the Impact trial at Deakin University.

The down side of participating in this trial, is that I could not have any treatment that would impact on the structure of my bones whilst on the trial.

It has been apparent for a few months now, that treatment would be necessary.The trial ends on the 30th of this month so I can now start on either of the treatments you have mentioned.(Not before time I might add.)

 

Thanks for the heads up on Pain Management. I took note when I heard you talking about your Pain Management (using  Fentanyl Patches) on one of our phone in conferences. The main problem I have in respect to pain management is this:- I need to drive and the Laws here in Victoria are somewhat hazy in respect to driving when taking prescription medications. I am seeking clarification but it is a vexed question, and I am still waiting a definitive answer.

Regards,

Barree.

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DavidAbrahams

Hi Barree,

Re your last paragraph I suspect the legislation with respect to driving and using prescription drugs, especially the likes of Fentanyl is the same in all States and territories. (A Hazy Gray) I have been meaning to drop into our local Police Station and have a yarn with them. Will keep you posted.

 

Cheers

David

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