Next treatment options

[MechD]

Greetings,

I've completed my 13th session of cabazitaxel/carboplatin + daily prednisone which started in Jan of this year. I've tolerated it well with minimal size effects (peripheral neuropathy) and no nausea. I'm also getting Zometa every 4 weeks and Lupron twice/year. Bone mets on my last Bone (July) and CT (Aug) scans showed some regression and I have no bone pain. My PSA went from 51 in Jan. 2022, bottomed out at 0.40 in June and has increased to 0.88 on 10/18. My primary MO suggested I start checking on clinical trials and consult with my secondary MO, Dr. Verma at UC Davis Cancer Center. Dr. Verma recommended, since my PSA is so low and I've had 13 chemo treatments, that I drop the carboplatin for a partial chemo break but continue the cabazitaxel and watch the PSA. If it rises (already is), to re-challenge with either:

1. Lupron + Zytiga or Xtandi, no chemo (I've previously not had Xtandi) or

2. Lupron + Lynparza, no chemo (I have BRCA2 mutation)

Please share any thoughts and suggestions on the next treatment options.

Thank you for your kind consideration!

[Tall_Allen]

When you wrote how successful Jevtana+carboplatin has been, my first thought was "probably BRCA+." The reason is that the chemo combo and PARP inhibitors are usually successful in the same people. You've had 13 treatments, which is a lot. Maybe time to switch to a PARP inhibitor now.

If you're in the US, there are a couple of trials of a PARP inhibitor+2nd Gen hormonals you might consider:

clinicaltrials.gov/ct2/show...

clinicaltrials.gov/ct2/show...

There is also this trial of Lynparza and Xofigo that you seem perfect for:

clinicaltrials.gov/ct2/show...

[MechD in reply to Tall_Allen]

Thank you so much! I will follow the links.

[tango65]

I would do the lymparza (Olaparib) plus ADT. It has a good efectivity in controlling BRCA 2 cancers

nejm.org/doi/pdf/10.1056/NE...

[MechD in reply to tango65]

I'm hoping Lynparza + Lupron will be effective longer than when I took it pre-chemo. I am looking at the PARPi + Lupron + Zytiga or Xtandi as TA suggested. Am I correct that this would only be available in clinical trials and not SOC?

[tango65]

Zytiga and Olaparib are approved for mCRPC, it will depend on the imsurance paying for both at the same time.

Zytiga plus Olaparib is more effective than Zytiga plus ADT.

If I understood correctly your cancer was never exposed to any of the new anti androgens. It may have a good response to Zytiga which is very effective med for metastatic PC.

[MechD in reply to tango65]

I’ve been on Lupron since 2016 and during that time I have had both Zytiga and Lynparza but not together and have never been on Xtandi. I’m meeting with my MO tomorrow and will discuss the combos as well as insurance. Thank you!

[tango65 in reply to MechD]

Since you have a lot of chemo the cancer may respond to Zytiga.

I wish you the best of luck with the treatment.,

[HopingForTheBest1]

I will be starting my 12th round of Jevtana/Carbo next week Nov 1. Also tolerating fairly well, except for the first 7-8 days after each treatment. Eligard and Xgeva every 3 months. Updated scans coming this Nov 15. Unfortunately, my PSA # is no where as low as yours.

I am BRCA2+, which was diagnosed back in Jan 2019. Went on Lynparza, before FDA approval. Results kept my PSA undetectable for close to 2 years until it ran its course.

Based on the scan results, I will also need to consider next treatment option. Possibly Pluvicto, or another clinical trial.

[MechD in reply to HopingForTheBest1]

I hope your next scans look good. For possible next treatments, see above reply from Tall_Allen regarding clinical trials and from tango65 regarding Zytiga and Lynparza (Olaparib).

[HopingForTheBest1 in reply to MechD]

After having been treated with Olaparib, my BRCA2 mutation has changed and PARPs will no longer be effective for me.

[MechD in reply to HopingForTheBest1]

Since you've now had chemo, check with your MO to see if re-challenging with Olaparib could once again be effective.

[HopingForTheBest1 in reply to MechD]

Not an option for me.

[Hidden]

Hi MechD

How were your side effects from the cabazitaxel/carboplatin + daily prednisone. I am about to start on it.

Thanks,

Tom

[MechD in reply to Hidden]

It was very well tolerated for me, no nausea, some fatigue but minor, no loss of work. I do have some peripheral neuropathy in my right heel. However since starting chemo, I developed a blood clot in my right thigh so I'm not sure if that may have contributed. As a result of the clot, my MO put me Eliquis (blood thinner). I take a handful of vitamins and supplements which I'm sure helps, including mega dosing the vitamin C. I hope it goes well for you!

[Hidden in reply to MechD]

Thanks so much for getting back to me. My journey is now in its 21st year. I have been very lucky so far and really have only had significant treatment the last 7 years starting with lupron then adding zytiga, that didn't work, did six sessions of doxel texel, and now have just completed six sessions of the zofigo. The doxetaxel really kick the crap out of me but it brought my PSA down to 1 for a while. Which was good. What are your PSA numbers and alp now?

Thanks so much for your input.

Tpm

[MechD in reply to Hidden]

I was first diagnosed in 2011 so my journey has not been as long as yours. My PSA went from 51 in Jan. 2022, when I started cabazitaxel + carboplatin, bottomed out at 0.40 in June and has slowly increased to 0.88 on 10/18. We’ve decided to stay with the treatment till next bone and CT scans next month. Then based on scan results, we’ll decide if we need to change the treatment. My ALP is listed as alkphos and is currently 111 U/L.

[Hidden in reply to MechD]

Thanks so much for the info. Good luck in your journey.......

Tom

[MechD in reply to Hidden]

You as well Tom and may God bless you! Chris

[Hidden]

God Bless you, my friend.