Pluvicto (Lutetium-177): What to Expect

Pluvicto is the brand name. Lutetium Lu 177 vipivotide tetraxetan is the generic name. It has two halves joined together. One half seeks out PSMA, a protein sitting on the surface of most prostate cancer cells. The other half is lutetium-177, a radioactive atom that fires short-range radiation into whatever it is attached to.

Because it only works where PSMA is present, a PET scan comes first. Your team uses an approved PSMA imaging agent to see whether your tumors light up. If they do not, this treatment is not for you. That scan is the gate, and it is worth asking to have the result explained.

Pluvicto is for adults with prostate cancer that has spread, is PSMA-positive, and is still growing despite testosterone being kept low. Beyond that, the label sets two more conditions.

You must already have had an androgen receptor pathway inhibitor, a class that includes tablets such as enzalutamide and abiraterone.

And you must fall into one of two groups: either you have already had taxane chemotherapy, or your team judges it appropriate to delay taxane chemotherapy. That second route is the newer one. It means you no longer have to have had chemotherapy first to be eligible.

The course is six doses into a vein, about six weeks apart, so the whole treatment spans most of a year. Treatment stops earlier if the cancer grows or side effects make it unwise. The radioactive amount in each dose is fixed by the label and measured out by the nuclear medicine team — it is not a number you handle, so it is not printed here.

The injection itself is quick. The visit is longer, because of preparation, checks and radiation handling. Blood tests and kidney function are reviewed before each dose.

You go home mildly radioactive, and the label sets out what to do about it.

• Drink plenty and empty your bladder often, both before and after the dose. This clears the drug faster and reduces the radiation dose to your bladder.
• Keep more than 3 feet away from other people where you can for 2 days, and from children and pregnant women for 7 days.
• Sleep in a separate room from other adults for 3 days, from children for 7 days, and from a pregnant woman for 15 days.
• Avoid sexual activity for 7 days.

Sit down to use the toilet, flush well, and wash your hands thoroughly. Your nuclear medicine team will give you written instructions; keep them where you can find them.

Dry mouth is the effect people notice most, because salivary glands also carry PSMA and pick up some of the radiation. Sipping water, sugar-free gum and saliva substitutes help. Tiredness, nausea and reduced appetite are common.

Blood counts can fall, sometimes several weeks after a dose. Report unusual tiredness, pallor, breathlessness, easy bruising or bleeding, or signs of infection such as fever, chills, sore throat or mouth ulcers.

The kidneys clear the drug, so staying well hydrated protects them. Kidney blood tests are checked as the course goes on. The label also notes that treatment may cause temporary or permanent infertility, which is worth raising before the first dose.

• Call 911 or go to an emergency department if bleeding will not stop, you are breathless at rest and very pale, or you stop passing urine altogether.
• Treat a fever as an emergency, not a same-day call. If your temperature reaches 100.4°F (38°C) or higher, or you get shaking chills, phone the oncology or nuclear medicine line at once and head for the emergency department if you cannot reach anyone. The CDC classes fever during cancer treatment as a medical emergency. Blood counts can fall weeks after a dose, so this holds between visits too.
• Call your care team the same day if you get a sore throat, mouth ulcers, or burning when passing urine without a fever.
• Call your care team within a day or two if you bruise for no reason, feel worn out beyond your usual, cannot keep fluids down, or your urine volume drops while you are trying to drink more.

Say that you have had a radioactive treatment when you call, and take your written radiation-safety instructions with you.

https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=14908037-2892-4d98-a053-253ce35afb1a

https://www.cancer.gov/about-cancer/treatment/drugs/lutetium-lu-177-vipivotide-tetraxetan