About Your Pluvicto™ Treatment

This information will help you get ready for your Pluvicto treatment at MSK. Pluvicto is a type of radionuclide therapy called radioligand therapy (RLT).

About Pluvicto

Pluvicto is a targeted radioactive therapy. It has 2 main parts, targeted and radioactive.

• The targeted part finds and binds to cancer cells. It uses prostate-specific membrane antigen (PSMA) receptors on your cells.
• The radioactive part uses radiation (waves of energy). The radiation harms and kills cancer cells.

Pluvicto is used to treat metastatic castration resistant prostate cancer (mCRPC) that’s PSMA positive. This type of cancer is also called prostate cancer that has progressed.

Your healthcare provider will recommend Pluvicto treatment if your prostate cancer:

• Does not respond to hormone treatment that lowers your testosterone.
• Has spread to other parts of your body.
• Is found on either of these imaging studies:
  • PSMA PET-CT (positron emission tomography and computed tomography) scan.
  • Pylarify® PET-CT scan.

Pluvicto is given as an intravenous (IV) infusion. An infusion is when medication is put into your bloodstream through a vein over a period of time.

Getting Ready for Your Pluvicto Treatment

Before you get Pluvicto, you will meet with a healthcare provider from the Molecular Imaging and Therapy Service (MITS). This is sometimes called the Nuclear Medicine service. You can meet with your MITS provider in-person at MSK’s main hospital, or have a telemedicine visit. You will need to have some blood tests before your appointment.

During your appointment, your MITS provider will review your medical history, recent bloodwork, and any recent scans you had. This includes a PSMA or Pylarify PET-CT scan that confirms you have PSMA-positive prostate cancer.

Your MITS provider will use your medical history and blood test results to decide when to start your Pluvicto treatment.

Your MITS provider will also ask you about your medications. Make sure they know all the medications you’re taking. This includes patches, creams, prescription medications, and over-the-counter (not prescription) medications.

Once your MITS provider has decided it’s safe for you to start treatment, they will go over the side effects. They will also give you information about your Pluvicto treatment schedule and discuss your treatment goals.

Pluvicto treatment schedule

Pluvicto treatment is given as 6 separate infusions. The infusions are about 6 weeks apart. You will come to the main hospital at MSK for each infusion.

During your Pluvicto treatment, you will have regular blood tests to monitor your health. This is to check your blood cell counts.

These tests will also check your nutrition, electrolyte levels, and if your liver and kidneys are working normally. You can have these blood tests done at the MSK location closest to you. Bring your appointment calendar with you to each treatment to schedule your next cycle and future lab appointments. The timeline below shows your Pluvicto treatment schedule (see Figure 1). 

About Your Pluvicto Infusion Appointments

Your infusion appointments will take most of the afternoon. Please do not schedule other appointments on your treatment days. You should plan to be at your appointment for 3 to 4 hours. You can find the exact time in your MyMSK account. You may want to bring a book or other things to keep yourself busy during your appointment. You can also bring food and a drink.

Where to go for your Pluvicto infusion appointments

Your Pluvicto infusion appointments will be in the MITS therapy suite. To get to the suite, enter the hospital through the entrance at 1250 1^st Ave. (between East 67^th and East 68^th streets). Turn left at the security desk in the lobby. Go up the stairs and check in at the reception desk at the top of the stairs. You can wait in the waiting area. A staff member will come and bring you to the MITS therapy suite.

If you need an elevator instead of the stairs, or if you have questions, ask the security guard for help.

What to expect during your Pluvicto infusion visits

In the MITS therapy suite, you will sit in a private room with a TV and Wi-Fi.

Before your infusion, your MITS provider will review your medical history, your new or recent symptoms, and your medications. They will also perform a physical exam. They will review your blood counts and answer your questions.

A nurse will measure your vital signs (pulse, temperature, breathing, and blood pressure). They will also place an IV line (thin, flexible tube) into a vein in each of your arms.

Some people have a central venous catheter (CVC). This can be an implanted port (Mediport^®), tunneled chest catheter, or peripherally inserted central catheter (PICC). If you have a CVC, the nurse will place an IV line into it. They will place the other IV line into a vein in your arm or hand. If you don’t have a CVC, they will place an IV line into each of your arms or hands.

Your Pluvicto appointment will take 3 to 4 hours.

Medications you will get during your Pluvicto infusion visits

You will get a few different medications during your infusion visits.

• First, you will get anti-nausea medications. These are medications to keep you from vomiting (throwing up) or feeling nauseous (like you’re going to throw up).
• After the anti-nausea medications, your nurse will connect a saline hydration (water with a small amount of salt) to one of your IV lines. It will be infused slowly, over 2 hours.
• Your MITS provider will connect Pluvicto medication to your other IV line. It will be infused over 20 minutes. If you have friends or family with you, they cannot be in the room during your Pluvicto infusion. They will be asked to wait in the waiting area to avoid exposure to radiation.

During and after your Pluvicto infusion, you may have the following side effects:

• Fatigue (feeling more tired and weak than usual).
• Dry mouth.
• Nausea.
• Decreased appetite.
• Change in bowel movements (poop). This can be constipation (pooping less often than usual) or diarrhea (loose or watery poop).
• Low blood counts. A low blood count may delay the start of your treatment.

A nurse will stay with you during your entire treatment to help with these symptoms if they happen.

Nuclear medicine scan

After the saline hydration is finished, you will have a nuclear medicine scan. This checks where the Pluvicto went in your body. You will be lying down during the scan. It will take about 10 minutes. You will be discharged (leave the hospital) after the scan.

Radiation safety measures for yourself and others

After your Pluvicto infusion, there will be radiation coming from your body. A radiation safety officer is a staff member who is a specialist in radiation safety. They will talk with you about your radiation safety precautions before you leave your injection appointment. They will also give you written instructions to follow at home.

Follow the radiation safety measures below, and the radiation safety officer’s instructions, to keep from exposing others to radiation.

• Do not use public transportation (such as a bus or train) right after your infusion appointment. If you do need to use it after treatment, contact radiation safety for more details. It’s OK to use a car service. If you’re driving with another person in the car, sit as far away from them as you can. You should also do this if you are using a car service.
• Avoid being in close physical contact with other people. It’s fine to be in close contact with another person for a short period of time (such as a brief hug). But most of the time, stay at least 3 feet (about an arm’s length) away from other people.
• Practice good hygiene, such as washing your hands well with soap and water after using the bathroom. Some of the radioactive material will be in your body. It will leave through your blood, urine (pee), saliva, and other body fluids during the first few weeks after treatment.

The number of days you must follow these precautions is based on your specific Pluvicto treatment. It can range from 2 to 11 days. In general, you will be asked to:

• Stay at least 3 feet away from others for the first few days after treatment.
• Sleep alone for 4 days.
• Avoid holding or sleeping with small children or pregnant people for about 9 to 11 days.

Some security equipment (such as at the airport or outside a tunnel) can detect very small amounts of radiation. A staff member will give you a card that says you had radioactive medicine. It says you can give off small amounts of radioactivity for up to 2 months after your treatment. If you’re stopped by law enforcement at a checkpoint, show them this card. If you have any questions about radiation safety, call 212-639-7391 Monday through Friday from 9 a.m. to 5 p.m.

After your Pluvicto infusion visits

• Follow the radiation safety instructions that the radiation safety officer gave you.
• Drink lots of liquids after each infusion. This will help the radiation from the Pluvicto leave your body more quickly.
• Tell your healthcare provider right away if you have any new symptoms or if your symptoms get worse. This includes urinating (peeing) less often or urinating much smaller amounts than usual.
• Some people may need medical care during the first 2 weeks after a Pluvicto infusion. This includes an operation or hospital admission. If you do, tell one of your healthcare providers that you have been treated with radioactive Lutetium-177. There can still be some radiation in your body.

Contact Information

If you have any questions or concerns, please call the Molecular Imaging and Therapy Service:

• Monday through Friday from 9 a.m. to 5 p.m., call 212-639-3146. Ask for the Molecular Imaging and Therapy Service nurse.
• After 5 p.m., during the weekend, and on holidays, call 212-639-2000. Ask for the Molecular Imaging and Therapy Service fellow on call.