Hi-Risk/Recurrent/Advanced PCa Video Chat, Apr 4, 2022
Next meeting will be on Apr 12, 2022.
All AnCan’s groups are free and drop-in – join us in person sometime! You can find out more about this and our other 10 monthly prostate cancer groups at https://ancan.org/prostate-cancer/ Sign up to receive a weekly Reminder/Newsletter for this Group or others at https://ancan.org/contact-us/
Editor’s Pick: Heads up for a marathon session this week. And we keep returning to 2 topics …. intermittent hormone therapy (IHT), and of course Pluvicto (rd)
Topics Discussed
original low Gleason progresses to advanced PCa over 21 yr period; do you buffer on resuming IHT; Epstein reclassifies 3+3 to 5+4 with treatment implications; weighing time to Pluvicto availability with a trial now; stay with chemo or shift to Pluvicto?; Herb’s last man under the wire; starting darolutamide (Nubeqa); how long before testosterone returns?; after 5 yrs it’s time for IHT; side effects from chemo; post-Pluvicto – abi, Provenge, or …? ; alternative advanced disease markers; scan concordance is important for Pluvicto; vertebral fracture with advanced PCa may have implications.
Chat Log
Peter Kafka – Maui (to Everyone): 5:23 PM: Has the doctor suggested a PSMA scan while the PSA was up?
Len Sierra (Private): 5:39 PM: Rick, I’ve actually been on complete drug holiday since Jan. 12 of this year, so almost 3 months now. No Lupron, no daro.
Stephen Saft (to Everyone): 5:42 PM: my doctor told me it wouldn’t get approved but I fought for a long time and finally got him to put it through. It was approved and I had the Pylarify PET scan on March 4.
John Birch (to Everyone): 5:58 PM: Stephen, why the the doubt on insurance approval? Thats the isssue I am running into.
Frank Fabish – Ohio (to Everyone): 6:00 PM: Amir Mortazavi at OSU James Cancer Hospital
Stephen Saft (to Everyone): 6:00 PM: That is a very good question. I don’t know. I think the old school thinks that it won’t change treatment so the oncologist doesn’t like the idea.
Len Sierra (to Everyone): 6:23 PM: Steve, the half life of Ac-225 is 10 days and it takes 5 half lives to clear 95% of a drug, so you’re looking at 50 days of washout.
George Rodriguez-Chantilly VA (to Everyone): 6:29 PM: Rick, I need to drop off. Very informative. I’ll reach out later to get some information on what to expect with hormone treatment of Yonsa w/methylprednisolne in concert with Eligard.
Frank Fabish – Ohio (to Everyone): 6:29 PM: Rick I have to go. I have my 3 month check up and blood draw tomorrow. I’ll let you know results.
Ben Nathanson (to Organizer(s) Only): 6:30 PM: Len, aren’t these different half-lives? Isn’t drug clearance a function of pharmacokinetic half-life, not radioactive half-life?
AnCan Herb (to Organizer(s) Only): 6:31 PM: The biological half life is much faster. The unbound compound is excreted, and then the bound drug disappears with its half life. It is a two compartment model
Ben Nathanson (to Organizer(s) Only): 6:31 PM: Right, so less than 50 days
Len Sierra (to Everyone): 6:32 PM: Ben, I believe the greater concern would be the radioactive half life since that is the toxic payload.
Ben Nathanson (to Organizer(s) Only): 6:32 PM: But if it’s out of the body faster than that, it doesn’t matter if it’s still radioactive
Tony D’Errico – Cornwall, Ontario (to Everyone): 6:35 PM: I will see you all soon. bye for now.
Len Sierra (to Everyone): 6:35 PM: I guess we’ll have to consult with a nuclear medicine doc on this..
Ben Nathanson (to Organizer(s) Only): 6:45 PM: Herb, this video? “Lymphocytes as a “Living Drug for the Treatment of Cancer” and Emergence of the NIH cGMP Program to Support Patient Care Innovation” from 3/30?
AnCan Herb (to Organizer(s) Only): 6:46 PM: Yes, that should be it
Ben Nathanson (to Organizer(s) Only): 6:46 PM: Thanks!
John Birch (to Everyone): 7:08 PM: Thanks to all. Need to run apparently tornados are landing in the area.
David Muslin (to Everyone): 7:12 PM: Going to bed. See ya next week.
Stan Friedman (to Everyone): 7:23 PM: Good night. See you next week.
Mark Baldridge – Seattle (to Everyone): 7:57 PM: Thank you everyone for such good information – Kathy and Mark
Len Sierra (to Organizer(s) Only): 7:57 PM: Got to go, Gents. See ya next week.
George Rovder Arlington VA (to Everyone): 7:59 PM: Thank you all. Goodnight. George
On Wednesday, March 23 of this past week, the FDA finally approved Lutetium 177 PSMA 617 for treatment of PSMA (prostate specific membrane antigen) sensitive metastatic castrate resistant prostate cancer (mCRPC). The ligand, lutetium Lu 177 vipivotide tetraxetan, has a commercial name of Pluvicto, and is made by Advanced Accelerator Applications, a subsidiary of Novartis. Novartis is an AnCan sponsor – they have not asked us to make this post.
Pluvicto delivers the radionuclide agent lutetium to cells expressing PSMA . According to Dr. Jeremie Calais at UCLA, “The PSMA-targeted radioactive agent preferentially atttaches to cancerous cells, not the normal tissues”.
You can read the Novartis press release here, and an independent review from Prostate Cancer Foundation here.
The approval left a lot of open questions, several of which AnCan was able to answer when we spoke with AAA on Friday. There are a couple of quirks in the approval and availability.
Use of Pluvicto (Lu177 PSMA 617) is post-chemotherapy
Use requires a Ga68 PSMA 11 scan – not Pylarify. AAA received a companion approval for Locametz, a kit that makes that scan widely available. It is not clear if a previous Pylarify scan will be grandfathered
There is no Medicare pricing agreement as yet
All the managed access trial sites have now been closed. Each hospital will now have to approve local use itself – Hopkins, by way of example. has indicated this could take months. AAA has suggested the following sites may be ready to treat immediately:
University of Chicago
Tulane
Mount Sinai, NYC
UCLA
In the interim AAA Patient Connect is geared up to provide financial assistance. It can be reached via the number on https://pluvicto.com 844 638 7222
For a good indicator as to where Pluvicto could soon be available, you can check the sites where AAA’s Lutathera, a lutetium treatment for certain neuroendocrine cancers, is available. https://www.lutathera.com/find-a-treatment-site/
Hi-Risk/Recurrent/Advanced PCa Video Chat, Mar 7, 2022
It’s diet coke, spam and bacon wrapped twinkies for our meeting this week!
Next week’s meeting will be on Tue, March 21. That’s because Feb and March mess up our Meeting Calendar, so we have to make adjustments to avoid consecutive nights! Almost done with this crazy schedule. Come April, we are back to a normal schedule – 1st & 3rd Monday at 8pm, and 2nd & 4th Tuesdays at 6pm – all Eastern. All AnCan’s groups are free and drop-in – join us in person sometime!
Editor’s Pick: Recurring themes throughout this week – QoL and treating older Gents, heart/BP issues + old faves like Provenge, Lu177, immunotherapy and intermittent HT (rd)
Topics Discussed
Best treatment for asymptomatic 94 yr old with heavy tumor buruden; melatonin?;resumption after IHT; changing diet and exercise may have brought results; should clinical trials precede FDA approved Tx; Provenge vs newer immunotherapies; “How not to die” diet; switching HT regimen; William Hurt – alternative medicine; darolutamide/Nubeqa works; you can delay initial Tx for int/hi-risk PCa; ‘direct heart risks; more heart chat and older men discussions; are ttrial stes playing G-d with Lu177 patient selection; obtaining darolutamide … & Provenge.
Chat Log
6:08 PM Mike A to Everyone: i received the 4th covid shot in Seattle. Anyone being treated for cancer at UW hospital qualifes
6:22 PM Julian Morales-Houston to Everyone: Just saw Dr E today!
6:26 PM Joe Gallo to Everyone: Dr. Eleni Efstathiou Medical Contact details eefstathiou@houstonmethodist.org
6:29 PM Julian Morales-Houston to Everyone: her office: 346-238-4496; clinic: 713-441-9948
6:31 PM John Antonucci to Everyone: quite a few articles on melatonin and PCa actually. I haven’t read any yet
6:35 PM AnCan – rick to Everyone: Hi Gents …. am in DC to lobby for AUA. Have a reception but will be back in about 45′
6:44 PM Julian Morales-Houston to Everyone: HCTZ
6:45 PM AnCan – rick to Everyone: I could not tolerate HCTZ when they first put me on it with lisinopril. Been on lisinopril alone for more than 11 years. Very low dose.
6:46 PM AnCan – rick to Everyone: Guys …. gootta run fo rthe last 45′ of this networking reception
6:46 PM Herb to AnCan – rick: I’m having trouble with amlodipine edema.
6:46 PM Len Sierra to Organizers:m Ciao, Rick!
6:47 PM Julian Morales-Houston to Everyone: For BP I am on losartan/HCTZ 100/12.5 + Amplodine+Bystolic 10 MG
6:50 PM Mike A to Everyone:m thanks everyone, need to drop
6:56 PMLen Sierra to Everyone: MSI – Microsatellite Instability
7:00 PM Michelle G to Everyone: How do you know what biomarkers you have?
7:00 PM Len Sierra to Everyone: You ask them to do genetic testing, Michelle.
7:01 PM John Antonucci to Everyone: PSA is a biomarker. Genetic ones are detected with germline and somatic gene testing.
7:01 PM Michelle G to Everyone: Thanks Len. We had that, I believe. So if they didn’t identify one, then he doesn’t have a specific biomarker?
7:04 PM Joe Gallo to Everyone: Do you mean DNA variant(s) eg. BRCA2 vs. biomarker? Biomarkers are tests.
7:08 PM John Garbin to Everyone: Does anyone know what William Hurt prostate cancer status was when he was diagnosed in 2018? Media said it was terminal prostate cancer in 2018 and he passed away this week
7:09 PM Pat Martin to Everyone: I heard he had mets to his bones when Dxed
7:09 PM John Garbin to Everyone: thanks
7:11 PM Michelle G to Everyone: Someone had said that immunotherapy is good only if you have certain biomarkers, so I was just repeating that word
7:11 PM Carl Forman to Everyone: William Hurt was stage 4 with bone metastisis
7:12 PM: Michelle G to Everyone: William Hurt didn’t want to do traditional chemo. He did something called SEF chemo–side effect free. SEF chemo has not been peer reviewed
7:13 PM Len Sierra to Everyone: Guess it didn’t work, Michelle. : (
7:13 PM Michelle G to Everyone: Exactly
7:15 PM Michelle G to Everyone: We have to go. Thanks everyone
7:26 PM John Garbin to Everyone: Thanks Guys..have to go to meeting…Ciao
7:50 PM George Rovder Arlington VA to Everyone: Thank you Len, all Organizers, and all friends.
7:51 PM Ben Nathanson to Everyone: Thank you, George
7:53 PM Frank Fabish – Ohio to Everyone: Got to go guys.
Hi-Risk/Recurrent/Advanced PCa Video Chat, Mar 7, 2022
(Got it out early this week, ahead of travelling!)
We’ve all been waiting for Ben’s debut, and here it is on an almost record night with 57 particpants! He does a great job, ably supported by our Moderator Team.
Next week’s meeting will be on Tue, March 15. That’s because Feb and March mess up our Meeting Calendar, so we have to make adjustments to avoid consecutive nights! Almost done with this crazy schedule.
All AnCan’s groups are free and drop-in – join us in person sometime! You can find out more about this and our other 10 monthly prostate cancer groups at https://ancan.org/prostate-cancer/ Sign up to receive a weekly Reminder/Newsletter for this Group or others at https://ancan.org/contact-us/
Editor’s Pick: Using the same 2nd line anti-androgen for 3 or 4 years may be controversial; chopping and changing Tx can keep the cancer off balance (rd)
Topics Discussed
Newbie leads us to discuss long term use of 2nd line Anti-androgens; chop and change can keep cancer off guard; Medicare coverage; another low PSA, high Gleason at Dx; neurosurgery in short order puts Lu177 PSMA on hold; depression and anxiety more common than you think – best meds?; there’s a Hopkins multi-disciplianry clinic – but only for newly diagnosed seeking a treatment path; should you fast pre-chemo?; ask for Dr. Wassersug’s HT bible; new Canadian Advanced PCa Group starts soon; what’s causing weight swings; be sure to taper off steroids; Lu177 PSMA showing great results
Chat Log
William Franklin (to Everyone): 6:09 PM: Richard, we wish you and your wife the best and a speedy recovery.
AnCan – rick (to Organizer(s) Only): 6:17 PM: she’s a GU med onc
AnCan – rick (to Organizer(s) Only): 6:28 PM: Herb/Len/Peter …. is BRCA more common in African Americans??
Len Sierra (to Organizer(s) Only): 6:28 PM: Not sure.
AnCan – rick (to Organizer(s) Only): 6:36 PM: It was raised in the meeting I was in last week. Suggested that AA’s had higher incidence. I asked.
AnCan Herb (to Organizer(s) Only): 6:40 PM: This was in an ASCO abstract: In conclusion, we observed a significantly higher rate of BRCA1/2 in the African American population when compared to non-Ashkenazi Jewish Caucasians.
AnCan – rick (to Organizer(s) Only): 6:42 PM: Tx Herb
Richard Wassersug (to Everyone): 6:52 PM: Thanks!
Frank Fabish (to Everyone): 7:00 PM: Thank you guys. Got to run.
AnCan – rick (to Everyone): 7:04 PM: SVI must have been treated Richard
AnCan – rick (to Everyone): 7:07 PM: This must be our guy. What a horrible thing to happen ….. that can bring on disease for sure. Hearts go out to him.
James Miller (to Everyone): 7:16 PM: Okay
Jimmy Greenfield (to Everyone): 7:28 PM: Neither of those drugs are opiates!
C Huerta (to Everyone): 7:28 PM: Ok. Thanks for the update. Only the Xanax is a controlled substance.
AnCan – rick (to Everyone): 7:35 PM: Gents ….. FYI Dr. John is a psychiatrist …. and here as a peer.
AnCan – rick (to AnCan Herb): 7:36 PM: My peach is 75mg and the grey is 37.5
AnCan Herb (Private): 7:37 PM: According to the information I have the white is 225 extended release
Stephen Saft (to Everyone): 7:49 PM: I did a fast mimicking diet called Prolon. It worked well for me.
C Huerta (to Everyone): 8:01 PM: The “fasting”/calorie restriction before and after chemo was published by UCSF. The goal was to limit the side effects of chemo.
George Rovder Arlington VA (to Everyone): 8:01 PM:Androgen Deprivation Therapy Publisher : Demos Health
James Miller (to Everyone): 8:01 PM: I have to go now Thank you all for inviting me.
C Huerta (to Everyone): 8:02 PM: I heard about it in 2016, unfortunately after my chemo, so no anecdotal nformation from me. Got to go.
Stephen Saft (to Everyone): 8:12 PM: good night. Very tired.
Hi-Risk/Recurrent/Advanced PCa Video Chat, Mar 1, 2022
AnCan was honored by the GU ASCO 2022 Conference in mid-Feb, where we pesented our abstract and poster. You can see just how effective our support groups (and recordings!) truly are: https://ancan.org/ancan-recognized-by…
If you missed Dr. Rachel Rubin’s excellent webinar on Intimacy and Sexual Dysfunction, watch the recording at https://ancan.org/webinar-cancer-chro… Next week’s meeting will be on Mon, March 7. That’s because Feb and March mess up our Meeting Calendar, so we have to make adjustments to avoid consecutive nights!
All AnCan’s groups are free and drop-in – join us in person sometime! You can find out more about this and our other 10 monthly prostate cancer groups at https://ancan.org/prostate-cancer/ To sign up to receive a weekly Reminder/Newsletter for this Group or others, go to https://ancan.org/contact-us/
Editor’s Pick: Wot a session – we covered everything! You choose this week … and leave a comment (rd)
Topics Discussed
How reliable is C-11 acetate scan?; Pylarify locations; where do you find PSMA protein?; brain fog from enzalutamide; ARASENS trial; Lyrica for sciatica?;shower safety; postural hypotension; Ssign up for ZERO Summit; PROPEL trial – abi + olaparib/PARP-I; PARP vs anti-PD1; cardio-oncology issues and presentation; abscopal effect may improve PARP-I; finally something works WELL – cabazitaxel + carbo; anemia and Procrit; resuming abi may have worked; prednisone vs dex with abi
AnCan – rick (to Everyone): 4:50 PM: Postural Hypotension
Dennis Correia Arizona (to Everyone): 4:53 PM: Leaving the meeting early for another meeting this evening. Great discussion among the regulars tonight.
Len Sierra (to Everyone): 4:54 PM: Frank, I think you’ll find this little book very helpful for low back in general. It’s called, Treat Your Own Back. It’s very inexpensive.
Tumor responses improved following a steroid switch from prednisone to dexamethasone in castration-resistant prostate cancer patients progressing on abiraterone:
Conclusions: Durable PSA responses occur in up to 40% of patients following a ‘steroid switch’ for PSA progression on abiraterone and prednisone. Studies are ongoing to elucidate the mechanisms underlying this response.
Jerry Pelfrey – Mexico (to Everyone): 5:50 PM: got to go my son called
George Rovder Arlington VA (to Everyone): 5:55 PM: Thank you Peter and all
