reply to Sr Sailor regarding variable responses to 177Lu-PSMA-
some correlations exist-
Some extreme responders also carry BRCA mutations, which cause defect in repair of double strand breaks, which the radiation causes to happen in cancer cells
over many administrations of the drug in Europe and Australia, patients with only lymph node metastases seem to fair better; median PSA decline of 92% vs 72% in patients with nodal mets plus only 1 or 2 bone mets; longer time to progression, better survival.
there was a trial of this drug that predated VISION here in the states; used a "cost-recovery" mechanism where subjects could be in a trial if they paid $10K per injection for the drug; shut down now due to lack of relevance because of VISION, but one subject showed mixed response after two injections: very substantial increase in bone and organ met volumes with 97% decrease in lymph met volumes
reference for lymph node study https://doi.org/10.18632/oncotarget.26789