For six months, the Orléans University Hospital has been offering a fairly innovative treatment for prostate cancer. The results are encouraging. Dr. Hélène Besse, nuclear doctor at the hospital, explains to us how it works, on the occasion of Movember, male cancer awareness month.
Since April 2024, the Orléans hospital has had a new weapon in its arsenal in the fight against prostate cancer. This treatment, available only since 2022, was only offered in large centers. The CHU, and in particular under the leadership of Doctor Hélène Besse, a doctor specializing in nuclear medicine, has therefore joined this club.
“We fought to have it. We have already included 30 patients. Whereas as of June 30, 2023, only 22 patients had been treated in Tours,” she rejoices. That is to say 30 patients included, already (compared to 22 in Tours).
This treatment, which could be described as “last chance”, is aimed at patients resistant to all other treatments, that is to say hormone therapy and chemotherapy. “Its name is RIV, for vectorized internal radiotherapy (the drug produced by AdAcAp, a Novartis subsidiary, is called Pluvicto). To summarize, I tell them that it is “radioactive chemo”. Chemotherapy floods all cells without distinction. There, it is more targeted. We consider that there is a receptor on the metastases. We place a ligand (molecule) there and we attach a radioactive molecule to it. Lutetium-177) which emits short and powerful beta radiation to destroy the tumor cell.”
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How is it going?
How does it actually work for the patient?
“He comes for six treatments six weeks apart and stays all day, in the day hospital. Between two treatments, we take two blood tests to monitor the PSA which is supposed to decrease. Thanks to images taken by a gamma -camera, we see the day of the treatment if the Pluvicto is well fixed on the metastases.”
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Jean-Claude lives in Saint-Brisson-sur-Loire and comes for his first session. He is sitting on an armchair, in a box with a television. The product was injected into his left arm. “When the oncologist told me about it, I immediately said yes. The three chemos tired me a lot and had no lasting effect,” he explains. Dr. Besse coordinates with the oncologists at Oréliance: “I have regular contact with them because they provide visits between treatments. Things are going very well.”
Jean-Claude should have fewer side effects: “Nothing the same day and possibly nausea and fatigue afterwards. And sometimes the feeling of dry mouth.”
20,000 euros a dose
The treatment is early access, that is to say that the High Health Authority has given the green light, but you have to take a lot of steps to obtain it. And above all, “the doses are manufactured in Italy and must be ordered three weeks before the treatment and canceled at the latest seven days before”. At 20,000 euros per dose, we must ensure that the patient will honor his appointment. “The dose arrives especially for the patient, via specific transport in a leaded pot. Otherwise, it is lost…”
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The effectiveness of this treatment is “encouraging”:
“We will not cure them but we can put the disease on hold for a few months. Two-thirds of our patients are stabilized or significantly improved. We have an 88-year-old man who responds very well and who has divided his PSA level. Their morale rises when this level drops. We give hope for prolonging life and we avoid the complications of bone metastases, pain…”
The men treated at the University Hospital sometimes come from far away: the Paris region, Chartres, Bourges, Blois, etc.
“Demand is high and services are full. Some Parisian centers have closed due to lack of staff or doctors to carry the unit.”
No risk in Orléans where the therapy team (a radiopharmacist, a medical physicist, three technicians, two people competent in radiation protection, a quality engineer, a healthcare executive and soon two doctors) is very empathetic and involved and dedicates three days per week (i.e. six patients divided into the two boxes) and soon four to this treatment.
Accustomed to seeing patients once for a scintigraphy or a PET scan, the mission of these professionals changes a little: “We become a clinician again. It is very rewarding to follow the patients but it is also difficult, emotionally, because we are ‘attached.”
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