Options after SOC have failed

[Eddy-Merckx]

I am starting Keytruda very soon and if it fails I will have exhausted all of my standard of care (SOC) options. Currently, I have lesions in a few lymph nodes in my abdominal and chest region that are continuing to show mild progression. Other than trials, what are our options beyond SOC? My oncologist says that it doesn't make sense to revisit treatments I have completed several years ago, even if they were effective then. What have folks done when they have exhausted their SOC options? Thanks.

[lcfcpolo]

Is Enzalutamide or Darolutamide an option even though Zytiga failed? What about Pluvicto LU177 or an Actium treatment such as AC-225 or J591. Good luck and sorry I cannot help more.

[Eddy-Merckx in reply to lcfcpolo]

I am sorry that I have not updated my bio in a long time. In the last 4.5 years, I have gone through docetaxel, Zytiga, darolutamide, Pluvicto, radiation to the pelvic region, cabazitaxel with carbiplatinum, and I am now on Xtandi with the PARP inhibitor talazoparib. I have a high mutational burden (24 genetic mutations), which is why my oncologist wants me to move to Keytruda. Given that everything I have tried has failed in the last four months and Keytruda is my last SOC option, I was wondering what comes after the SOC options are exhausted. I will look into AC-225 and J591. Thanks.

[TeleGuy in reply to Eddy-Merckx]

How is the talazoparib treating you? It’s on my plate of future options.

[Eddy-Merckx in reply to TeleGuy]

It's going well with minimal side effects (which are mainly a little stomach distress and fatigue) and it has not negatively influenced my blood counts.

[TeleGuy in reply to Eddy-Merckx]

Good to know, thanks! Hopefully it helped for a while.

[Ramp7]

I entered a trial study with LuPSMA177. A total of 6 infusions. I responded for a little over a year. This was after Lupron and Zytiga were failing. Presently doing BAT with favorable results. urotoday.com/video-lectures... One could also chec k out Dr. Gary Onik in Florida. garyonikmd.com/

[Eddy-Merckx in reply to Ramp7]

I am happy to hear BAT is providing favorable results. I will definitely look into that. Good luck!

[OsloN in reply to Eddy-Merckx]

BAT and ARSi, you have to do both. I am following the STEP-UP trial theraphy, very good results.

ncbi.nlm.nih.gov/pmc/articl...

[Ramp7]

Is this Eddy the Bike ridder?

[Eddy-Merckx in reply to Ramp7]

Fan of Eddy.

[addicted2cycling in reply to Eddy-Merckx]

Fan 👍👍, and do you RIDE?? 😁

[Eddy-Merckx in reply to addicted2cycling]

I love to ride, both road and MTB. The ADT has taken a lot out of me, but I usually feel good after a ride. I am guessing you like to ride, too.

[addicted2cycling in reply to Eddy-Merckx]

Ride as much as I can. Rode 35.53 miles this morning. Live by Rotonda West so all FLAT as a pancake. Planning on getting out tonight riding around Rotonda for a NEW MOON Ride hopefully 50 miles.

Keep turning those cranks the best you can.

[Eddy-Merckx in reply to addicted2cycling]

Nice! Keep riding.

[addicted2cycling in reply to Eddy-Merckx]

Only managed 44.44 slow moving miles so will try on May 23rd for a 50 mile FULL MOON ride.

[Serg59]

Maybe this information will interest you

ncbi.nlm.nih.gov/pmc/articl...

[Eddy-Merckx in reply to Serg59]

Thanks!

[GAdrummer]

🤞Keytruda works for you. My husband got lucky and is now 4.5 yrs. 0 PSA. It came at a price, you will need monitoring for the onset of side effects which are lethal if not constantly treated with meds. You will know quickly if you are a super responder. In one month his PSA dropped an order of magnitude and after 3 months he reached undetectable.

[Eddy-Merckx in reply to GAdrummer]

I am happy to hear your husband responded so well and I hope he has many more years at 0 PSA.

[Concerned-wife]

keytruda worked wonders for a friend of ours with a genetic mutation. . Hope it does for you!

[janebob99]

High-dose transdermal estrogen therapy may be helpful. Also, BAT.

[Eddy-Merckx in reply to janebob99]

Thanks.

[wat380bjw]

I am in a similar situation. I have lymph only disease, I did 10 rounds of Docetaxal and now on to caboplatin and Jevtana, The first cycle of the combo has my psa rising to 7.2 from 4.4 . I am interested if Keytruda works for you. My genomic testing says it is a good option for me. Thanks for your info. Brad

[Eddy-Merckx in reply to wat380bjw]

I will update my profile with more information about whether Keytruda worked. Genomic testing does seem to provide useful information about effective treatments. Good luck!

[MarkBC]

I'm curious about your oncologist's comment. I've been battling this for almost 6 years. The ADT and abiraterone are keeping the cancer suppressed with my PSA undetectable and no growth visible on scans. I had a great result with my initial docetaxel. PSA dropped from 103.0 to below 0.2. Since I had such a good result six years ago, my oncologist said we will probably try another round of docetaxel once my current treatment starts failing. I'm wondering if there is any science supporting a decision not to repeat an earlier successful treatment.

[Eddy-Merckx in reply to MarkBC]

My oncologist did not provide any reasons (yet) for why I cannot revisit previous treatments. Given docataxel worked for me 4.5 years ago, I may push for it if Keytruda fails. Thanks.

[HikerWife in reply to MarkBC]

Mark, fwiw, our oncologist at Dana Farber also told my husband Eric that he will almost certainly need to have another round of Docetaxel at some point. He had his first round a year ago. He's currently on abiraterone/pred and lupron. He said something like "docetaxel always works".

[God_Loves_Me]

Please do not consider my comment as Advice. my comments are base on google search, reading from groups's comments and discussion with MO.

Please read update of 2024

AUA 2024: mCRPC: Key Updates in Radioligand Therapy, PSMA Sensitive Disease

healthunlocked.com/advanced...

Here are my suggestions

1 option

Clarity Update: Complete response in first patient ever treated with 2 doses of Cu-67 SAR-bisPSMA at 8GBq

healthunlocked.com/advanced...

2 option

AMG 509 Clinical trial - NCT04221542. Very strong response in many patients

healthunlocked.com/advanced...

3 Option

AC-225 - Already may have in list.

4 option may be :

Ketoconzole - I am also learning but someone mentions works really well for 1 year. if you talk to your doctor please update me so I can add in my notes as well.

5 option

Terbium-161 may be next year it will available for clinical trial in usa

pubmed.ncbi.nlm.nih.gov/311...

6 option

Our lead product, FK-PC101, is for the treatment of prostate cancer patients with a higher risk of recurrence after prostatectomy. FK-PC101 is based on its proprietary novel technology using the patient's own cancer cells to create specific Tumor Presenting Cells (TPC). Patients immunized with a personalized TPC have a multi-neoantigen immune response against cancer cells.

cellvx.com/

7 option

BXCL701, is an investigational oral innate immune activator being developed as a potential therapy for the treatment of aggressive forms of prostate cancer, pancreatic cancer, and other solid and liquid tumors

bioxceltherapeutics.com/our...

8 option

debulking surgery - surgey options for active lesion area (eliminating the mothership)

pubmed.ncbi.nlm.nih.gov/223...

9 option

list of immunotherapy drugs for prostate cancer

healthunlocked.com/advanced...

10 option

ARX517 is a PSMA targeted chemotherapy drug. It uses an antibody to find cells that have PSMA (ie, the cells that show up on a PSMA/PET scan) and then it inserts a tubulin inhibitor (a form of chemotherapy) into yhe cell. This is different from lutetium (pluvicto) which kills the cell with radiation. It’s cslled an antibidy drug conjugate (ADC) since it uses an antibody to find the cancer and it injects a chemotherapy drug into the cells. This is an important area of research today!

clinicaltrials.gov/study/NC...

healthunlocked.com/advanced...

I participated in ARX517 and looks promising

[Eddy-Merckx in reply to God_Loves_Me]

Thanks! The information is very helpful and it is great knowing there are so many options currently being researched.

[God_Loves_Me in reply to Eddy-Merckx]

talk to your mo about below clinical trial if he think this is better options for you

clinicaltrials.gov/study/NC...

ARX517 is a PSMA targeted chemotherapy drug. It uses an antibody to find cells that have PSMA (ie, the cells that show up on a PSMA/PET scan) and then it inserts a tubulin inhibitor (a form of chemotherapy) into yhe cell. This is different from lutetium (pluvicto) which kills the cell with radiation. It’s cslled an antibidy drug conjugate (ADC) since it uses an antibody to find the cancer and it injects a chemotherapy drug into the cells. This is an important area of research today!

I am also in ARX517 and looks promising

[j-o-h-n]

I repeat myself (as usual). Keytruda worked for my melanoma lung metastasis

BTW What's your age and where are you being treated? (if possible add that info to your bio. It's voluntary but helpful..... thanks).....

Hint: Always ride your bike against the traffic flow...... this way when you wake up from a coma you can remember and identify what hit you. Also check your chest for any backward lettering license plate indentations).

Update/Caution: The states listed below do not have license plates (tags) in the front of the cars so they will not leave an indentation on your chest if one of those cars hits you:

Alabama

Arizona

Arkansas

Delaware

Florida

Georgia

Indiana

Kansas

Kentucky

Louisiana

Michigan

Mississippi

Good Luck, Good Health and Good Humor.

j-o-h-n

[Eddy-Merckx in reply to j-o-h-n]

I am glad to hear Keytruda worked for your melanoma and lung mets. I am 53 years old and I am being treated at Dana Farber (I will update my profile).

[God_Loves_Me in reply to Eddy-Merckx]

Do you have access to "Alicia Morgans, MD, MPH" ? She is also at Dana Farber. She has all upto date knowledge.

[j-o-h-n]

Thank you Eddy-Merckx,

Geez, there are so many new meds coming down the pike that when you're my age you'll look back and say to your main squeeze "Hey dear do you remember the bad old days?"....

Good Luck, Good Health and Good Humor.

j-o-h-n