Anyone doing retreatment with Pluvicto? Do you have any specific criteria, other than KPS/Labs? I have a guy I treated 1 year ago and had a great response but PSA has slowly risen. There is limited literature that I can find.
Retreatment with Pluvicto
- Thread starter xrt123
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PSMA scan still shows PSMA uptake in bones and visceral disease but improved since prior to Pluvicto. 6 cycle at 200 mCi per cycle. Interruptions. GFR is 60. Labs are all appropriate, (Hgb 11 plt and white count are fine). PSA dropped form 400 to 5 with Pluvicto treatment now risen to 40 over 11 months. Med Onc says he has nothing else to offer.
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I think you can consider retreatment.
But you will need to be careful about toxicity (no-brainer!).
I'd perhaps think about getting an FDG-PET too, just to be certain there are no discrepancies in the uptake (areas that no longer show uptake in PSMA but only in FDG).
But you will need to be careful about toxicity (no-brainer!).
I'd perhaps think about getting an FDG-PET too, just to be certain there are no discrepancies in the uptake (areas that no longer show uptake in PSMA but only in FDG).
D
deleted804959
General consensus is that we're overtreating and/or improperly treatment timing cycles. At this point I would be careful as the delayed renal and marrow toxicity will present around now. Your goal is to have enough of a PSMA-positive tumor burden to serve as a tumor sink (controversial term) for the Pluvicto to reduce exposure to already irradiated kidneys and marrow. Compare the pre-Pluvicto PET (I hope it was DCFPyL, but if PSMA-11, it's fine) to quantify mean tumor SUV as a sort of surrogate for PSMA-avidity/expression. You can do this on MIM if you have access to it, or ask your NucMed to quantify SUV metrics in a particular area (especially if symptomatic). If the patient is asymptomatic, I would wait until they become symptomatic to treat. There's no point in trying to rush things if asymptomatic, as I'm guessing the disease recurrence/persistence are in lesions that were present prior to Pluvicto, so you're basically just delaying the inevitable, or even hastening renal/marrow failure.
Another option is to consider Actinium on trial if that's an option for where you are. Probably the #1, 2, and 3 best options are palliative consult, palliative consult, and palliative consult.
I tend to space out my Pluvictos more than what is textbook, and am very comfortable stopping after 2 cycles to keep further treatments in my pocket when needed. I get PSMA PETs after every 2 cycles. The little published data for more than 6 cycles shows what you'd expect...bad news bears.
Another thing to consider is disease transformation, for which getting an FDG PET would be helpful. In these cases, if the tumor burden is disproportional with PSMA-avidity and PSA, be concerned for neuroendocrine transformation and potentially consider sending out for TMBs for possible palliative immunotherapy.
Another option is to consider Actinium on trial if that's an option for where you are. Probably the #1, 2, and 3 best options are palliative consult, palliative consult, and palliative consult.
I tend to space out my Pluvictos more than what is textbook, and am very comfortable stopping after 2 cycles to keep further treatments in my pocket when needed. I get PSMA PETs after every 2 cycles. The little published data for more than 6 cycles shows what you'd expect...bad news bears.
Another thing to consider is disease transformation, for which getting an FDG PET would be helpful. In these cases, if the tumor burden is disproportional with PSMA-avidity and PSA, be concerned for neuroendocrine transformation and potentially consider sending out for TMBs for possible palliative immunotherapy.
