Sunday, February 5, 2023

Lutetium 177 Treatment For Prostate Cancer

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Signs Of Prostate Cancer Spreading

Using Lutetium-177 Treatment For Prostate Cancer | Ask a Prostate Expert, Mark Scholz, MD

Firstly, the symptoms include the general complications of developing each kind of cancer . Secondly, it is essential to understand that typical symptoms depend on the localisation of metastases.

For example, if prostate cancer has spread into the bones, which is the most common situation, the patient suffers from bone pain, characterised as a constant stubbing or dull ache.

Except for this, when the prostate gland is enlarged, it can put pressure on the nearest areas, including the urethra, which will impede the urea passage.

Furthermore, prostate malignancy is very likely to spread to groin lymph nodes. Such a condition is usually followed by swelling and pain in that region.

Labelling Of Lu 177 With Psma Peptides: Different Available Options

There are a number of different PSMA peptides and antibodies9, 18 that have been labelled with 177Lu, and which have been utilised in both clinical trials and for clinical use as therapy agents in men with metastatic castrateresistant prostate cancer .4, 19, 20, 21 These include the compound PSMADKFZ617, with which most patients in the published literature to date have received their therapy. This is a small molecule peptide, rather than an antibody, chemically conjugated with 177Lutetium. In an initial study in mice, it has a highly efficient internalisation into prostate cancer cells with approximately 75% of the peptide bound to the cell internalised after 3 h of incubation.22 A similar small molecule PSMA peptide ending with a different chemical conjugation also appears effective as a therapeutic agent in a number of published studies.3, 21177LuJ591, a monoclonal antibody to the PSMA receptor has been used for the therapeutic treatment of prostate cancer, with effective results, but appears to have a more limited treatment response and higher myelosuppression than seen in the studies undertaken using the smaller PSMA labelled peptides18, 23

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Some Side Effects Could Be Serious

If you experience any of the following serious side effects, tell your nuclear medicine doctor or oncologist right away.

Very common: may affect more than 1 in 10 people

  • tiredness, weakness, pale skin or shortness of breath
  • bleeding or bruising more easily than normal or difficulty to stop bleeding and frequent infections with signs such as fever, sore throat or mouth ulcers

Common: may affect up to 1 in every 10 people

  • passing urine less often than usual or passing much smaller amounts of urine than usual
  • tiredness, weakness, pale skin, shortness of breath, bleeding or bruising more easily than normal or difficulty to stop bleeding and frequent infections with signs such as fever, chills, sore throat or mouth ulcers

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An Update To The Pilot Study Of 177lu

  • 1Department of Radiology and Nuclear Medicine, Radboudumc, Nijmegen, Netherlands
  • 2Department of Urology, Radboudumc, Nijmegen, Netherlands
  • 3Department of Medical Oncology, Radboudumc, Nijmegen, Netherlands

177Lu-PSMA-617 radioligand therapy is a novel treatment for end-stage prostate cancer, which could also be applied to patients with hormone-sensitive prostate cancer with high expression levels of prostate-specific membrane antigen . In this perspective, we review the recent results of toxicity, radiation doses, and treatment effect of 177Lu-PSMA in patients with low volume metastatic hormone-sensitive prostate cancer. Moreover, we present long-term follow-up data, such as toxicity and time without androgen deprivation therapy , of the patients who participated in this trial. Overall, 177Lu-PSMA appeared to be a feasible and safe treatment modality in this setting, as well as in long-term follow-up. We observed that men with a prostate-specific antigen response of more than 50% seemed to especially benefit from this therapy by postponing ADT and thus preserving the quality of life.

When Would I Consider Using This Treatmentkeyboard: Arrow: Down

Lutetium

Lutate therapy is used on people with cancer originating in the prostate. It is very specific and is used for managing metastatic prostate cancer or prostate cancer that is no longer responsive to other lines of treatment therapy. Candidates are identified after a Gallium 68 PSMA PET CT scan has been performed.

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Is This Treatment Safe

The radiation used in the Lutetium-177 is designed to only destroy the cancer cells. With theranostic, treatment becomes more personalized so that cancer and its metastasis are effectively pinpointed but the whole body is never exposed to the radiation. Only the cancer cells are irradiated and destroyed. Blood tests will be performed to makes sure that the radiation is not damaging healthy tissues. Imaging tests are also performed to ensure that the radioactive material at the tumor sites has been correctly absorbed.

Side effects of the therapy may include:

  • A brief decline in production of blood cells

After Procedure Recovery Time & Follow

After having Lu-177 PSMA Radiotherapy, most patients return home within 48-72 hours. They should avoid strenuous activities for 24 hours following the treatment.The following therapy can take place in 6-8 weeks. A patient may be recommended to have three treatments, but a single treatment may be enough.

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If You Forget To Receive Lutetium Vipivotide Tetraxetan

If you miss an appointment for an administration, contact your nuclear medicine doctor or oncologist as soon as possible to reschedule.

Should you have any further questions on the use of lutetium vipivotide tetraxetan, please ask the nuclear medicine doctor or oncologist who supervises the procedure.

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Is Lutetium 177 Psma Fda Approved

New FDA Approved: Pluvicto (Lutetium-177) for Advanced Prostate Cancer | Mark Scholz, MD | PCRI

177Lu-PSMA-617 is currently under review by the US FDA. In September 2021, the FDA accepted this new drug under priority review. The decision for approval is estimated to be made in the first half of 2022.

In June 2021, the FDA granted 177Lu-PSMA-617 a Breakthrough Therapy Designation . The BTD process is designed to expedite the review of drugs intended for serious conditions where early clinical results indicate improvement over already available therapies.

Note: This BTD status for 177Lu-PSMA-617 is not to be confused with the FDAs approval of another lutetium therapy: 177Lu-Dotatate, for the treatment of pancreatic and gastrointestinal cancers. While this therapy uses Lutetium-177 to treat cancers, it does not target the PSMA proteins found on prostate cancer cells.

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Before Starting The Therapy

First off, the therapy is applicable to patients with neoplasms with enough reactivity of prostate specific membrane antigen in the cellular structure of the tumor that is no longer activated by other treatments. And therefore, before starting this specific therapy for the treatment, the PSMA levels and the indications for the PSMA technique must first be checked. This is the universal principle at European hospitals. Another obligatory condition is the patient having normal kidney and bone marrow function.

Potential causes that may be a contraindication to this technique are conditions such as:

  • Severe liver and kidney dysfunction.
  • Severe chronic or autoimmune diseases.
  • Recent chemotherapy or bone-specific radionuclide therapy , or irradiation of a large area of the musculoskeletal system.
  • Brain metastases with signs of compression.

Who Is A Candidate For Pluvicto

Men with metastatic, castrate-resistant prostate carcinoma are potential candidates for Pluvicto. In other words, these are men whose prostate cancer has progressed despite prior therapies such as surgical resection, radiation therapy, androgen receptor pathway inhibition, and/or taxane-based chemotherapy.

PET/CT imaging with PSMA is required to confirm that the metastases will accumulate PSMA, and therefore respond to Pluvicto.

Guidelines may change in the future. Anyone interested is encouraged to discuss Pluvicto with their cancer care provider. Inquiries can be directed to Alex DiFonzo at 519-3456, ext. 2351, or the theranostics team at

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What Is Metastatic Prostate Cancer

Prostate cancer is a malignant prostate gland tumour with different stages depending on the size, engaging lymph nodes in the tumorous process and spreading. If the tumour is limited to the prostate and has not been extended, it is called localised prostate cancer. In locally advanced prostate cancer, the tumour has rolled out from the prostate to surrounding tissues.

If cancer develops further and extends to distant lymph nodes or other organs, it is called locally advanced or metastatic prostate cancer.

What Is The Effectiveness Of The Drugs

Lu177 Chloride (lu177 c.a)

The effectiveness of treatment with radiopharmaceuticals is most objectively reflected in the results of clinical trials. Unlike the practice of individual doctors, even in the largest medical centers with nuclear medicine, clinical trials include hundreds and thousands of patients with the same diagnoses. They help to collect large amounts of reliable information about the effectiveness of individual drugs, the incidence of side effects, and the possibility of combining different treatments:

  • According to the results of the VISION clinical trial, Lutetium-177-PSMA received FDA approval and the status of breakthrough therapy for metastatic hormone-resistant prostate cancer in 2021. This means that even the early clinical data strongly indicates the possibility of significant improvement in patients conditions compared to all other therapies. After 1 or several courses of treatment with Lutetium-177-PSMA, the 5-year survival rate of patients with metastatic prostate cancer increased to 30%. The risk of disease recurrence also decreased in 30-40% of patients, remission persisted for 2 years.
  • The trials on Actinium-225-PSMA are in their early stages. The results obtained so far show a 50-80% decrease in the number of metastases and a 90% decrease in PSA levels in 82% of men. In 2020, trials began on the combined use of Lutetium-177-PSMA and Actinium-225-PSMA.
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    How Much Does Lutetium

    Therapy with Lutetium-177 can only be done in the most advanced hospitals. Many third-world clinics do not have FDA approval to use this method. The average price of Lutetium-177 therapy is $10,000 per course. A person in the last stages of cancer should undergo 3-4 of such courses.

    The cheapest therapy is in Turkey, starting from $8,000. You can get it at Liv, Memorial, Medical Park clinics.

    Therapy with Lutetium-177 is the only chance for late-stage cancer patients. In this situation, any delay may be fatal. MediGlobus will help you sign up for the clinic and receive treatment. Write to us and we will answer your questions and arrange a medical trip.

    How Is Treatment Applied

    Lutetium-177 PSMA is performed with injections into bloodstream at 6- to 8-week intervals. On the day of treatment, an intravenous access is inserted and Lutetium-177 PSMA is administered into the blood vessel for 30 minutes.

    Moreover, antiemetic drugs and diuretic agents are simultaneously administered.

    A SPECT scan is performed 24 to 72 hours after the treatment to make sure that the agent reaches to the diseased body parts.

    4 sessions of treatment are required for most of the patients. PSMA PET-CT scan is repeated to evaluate treatment response at the end of the second session. If PSA level decreases and positive findings are noted in repeated PSMA scan, the remaining 2 sessions can be performed to complete the therapy to 4 sessions.

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    What Are Possible Side Effects

    The most common side effects are a dry mouth and eyes. Nausea and vomiting can be seen in some cases, although rarely. Mild somnolence is also among the side effects. Most of these effects are transient and they generally disappear after several days.

    For patients with diffused bone disease, suppression of bone marrow is also a potential side effect and this condition is caused by collateral damage to neighboring bone marrow by the radiation.

    Dosimetry Of 177lu Psma Therapy

    Spectrum News – Dr. Pliskin – Lutetium-177 PSMA treatment approved for late-stage prostate cancer

    Safety and efficacy of targeted radionuclide therapies can be improved with the use of patientspecific dosimetry, which may guide successful tumour dosing and act as an early indicator of organ toxicity.32 Of particular concern in 177Lu PSMA treatment are the kidney, salivary and lacrimal glands, which suffer from radiation dosing due to the physiological behaviour of the therapeutic peptide. As a result, imagebased dosimetry at each cycle of treatment is highly recommended33.

    SPECT CT whole body imaging 24 h postDose 1. 8.0 Gbq Lu PSMA Images demonstrate Lu PSMA uptake in multiple metastatic foci throughout the axial and appendicular skeleton. Serial time point imaging of the associated gamma emissions allows estimation of tumour dose delivered with each injection. SPECT CT whole body imaging 24 h postDose 2. 8.0 Gbq Lu PSMA SPECT CT images show a marked reduction in the intensity and number of Lu PSMA avid metastatic foci, which concords with the marked reduction in serum PSA in this patient.

    Lu 177 therapy is becoming a popular choice among men suffering from prostate cancer. Over the last few years, it has been seen that in many patients, Lu-177 treatment has reduced the size of the tumor.

    Men who have gone through radical prostatectomy or radiotherapy but have not seen results. They go for lu 177 therapy in Germany as their last treatment.

    Contents

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    Who Are Good Candidates For Lutetium Psma

    Lutetium-177 PSMA is employed for metastatic prostate cancer patients, for whom other treatment modalities, such as hormone therapy or chemotherapy, have failed.

    The patients should have a PSMA PET-CT scan before the treatment and PSMA receptors to be targeted in Lutetium-177 PSMA and their presence on cancer cells should be verified.

    What You Need To Know Before Lutetium Vipivotide Tetraxetan Is Used

    Follow all instructions given by your nuclear medicine doctor or oncologist carefully. They may differ from the general information contained in this leaflet.

    Your doctor must not give you lutetium vipivotide tetraxetan if you are allergic to lutetium vipivotide tetraxetan or any of the other ingredients of this medicine .

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    How Does Lu 177 Therapy Work

    PSMA is a type of protein that is expressed on the surface of the prostate cell membrane. It is believed that they have several cellular functions.

    When prostate cells are healthy, they produce low levels of PSMA. However, when a person suffers from prostate cancer, the prostate cell produces high PSMA. Often 1000 times more than a normal prostate cell.

    If the prostate cancer cell spreads to the other areas of the body. You will find that PSMA has also spread to those areas.

    Doctors use the excessive production of the PSMA to treat cancer. As we all know that Lu-177 is a reading-based treatment. Experts use this treatment to attach a molecule to the PSMA receptor located on the cancer cell.

    Lu-177 emits beta radiation that targets cancer cells and kills them.The whole process can take multiple exposures, depending on the canceled cells.

    The reason why experts use PSMA receptors is that using them can be precise as the Lutetium binds itself with the PSMA. This act of targeting the cancer is often known as PRRT Peptide Receptor Radionuclide Therapy.

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    How Lutetium Vipivotide Tetraxetan Works

    Lu177 Treatments

    Lutetium vipivotide tetraxetan binds to a protein called PSMA that is found on the surface of prostate cancer cells. Once bound, radiation is emitted from the 177Lu causing prostate cancer cells to die.

    Tests will be performed to see if PSMA is present on the surface of the cancer cells. Your cancer is likely to respond to treatment with lutetium vipivotide tetraxetan if the test result is positive.

    The use of lutetium vipivotide tetraxetan involves exposure to radioactivity. Your doctors have considered that the clinical benefit that you will obtain from the procedure with the radiopharmaceutical outweighs the risk due to radiation.

    If you have any questions about how lutetium vipivotide tetraxetan works or why this medicine has been prescribed for you, ask your doctor.

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    Lutetium Vipivotide Tetraxetan: Treatment Protocol: Information For Patients

    This publication is licensed under the terms of the Open Government Licence v3.0 except where otherwise stated. To view this licence, visit nationalarchives.gov.uk/doc/open-government-licence/version/3 or write to the Information Policy Team, The National Archives, Kew, London TW9 4DU, or email: .

    Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned.

    This publication is available at https://www.gov.uk/government/publications/lutetium-177lu-vipivotide-tetraxetan-in-the-treatment-of-prostate-specific-membrane-antigen-psma-positive-metastatic-castration-resistant-prostate/lutetium-177lu-vipivotide-tetraxetanin-treatment-protocol-information-for-patients

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    The Survival Rate Of Patients Undergoing Lutetium

      Lutetium-177 isotope therapy increases life longevity. Johnath Strossberg, American oncologist and researches, discovered that Lutetium-177 therapy has increased 3-year survival rate in 62% of his patients with stage 4 middle colon cancer. Without this therapy, only 10% of people with the same diagnosis have lived for 3 years.

      Patients at stage 4 of prostate cancer commonly have 9-12 months to live. Therapy with Lutetium-177 significantly improves their survival: in 64% of patients, the size of the tumor has decreased by more than a half. The life expectancy of patients after PSMA therapy with Lutetium-177 has increased by 50%.

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    Evaluation Of Response To Treatment:

    After completing the scheduled number of administrations of the labeled peptide, measurements are taken to determine whether there was any change in the PSA level. In addition to standard quality assessments, an evaluation of the size of lesions by Ga68 DOTANOC positron emission tomography/computed tomography scanning is performed at each three months interval after the last administration of the radioisotope.

    Why Should I Travel To Germany For Lutetium

    177 Lu PSMA Treatment for Prostate Cancer (Update: FDA approved on 3/23/22)

    The nuclear medicine community in Germany is extremely strong. Germany was home to the first study evaluating the use of 177Lu-PSMA-617 radioligand therapy for advanced prostate cancer patients.

    At the time, the multi-center study by Rahbar et al. had the largest number of patients participating at 12 centers around Germany. The study, initiated by the German Society of Nuclear Medicine, was available online in October 2016 and published in the Journal of Nuclear Medicine in January 2017,.

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