Next steps?

After 13 cycles of docetaxel and 4 of cabazitaxel, both have stopped working, at least alone. CT and bone scans yesterday both showed modest progression in mets in bone, lymph and liver. The shocker came today when I learned the PSA jumped from 1952 to 3580. I have no pain (knock wood), and have had no problems with nausea or fatigue during chemo. I have oncologists in Seattle and at Duke who will confer on treatment options while we wash my system with a short chemo break. If others who have faced this situation would share your experiences and treatments, I would appreciate the input. I have been through both Zytiga and Xtandi and continue to receive Lupron injections. I know my Seattle doc is participating in a trial using docetaxel, Carboplatin and sirolimus. The doctor ar Duke mentioned trying oxaliplatin with Gezmar.

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  • First sorry to hear about the treatment failure. My situation is similar in some ways. Dx'd in 2005 RP (failed) Salvage RT (failed). Long list of treatments including early chemotherapy etc. By early 2015 I had extensive bone and lymph node mets and multiple mets in my liver. 2015 saw use of Taxotere combined with Carboplatin and then Cabazitaxel. Still I progressed on scans. 2016 with a rapid PSA doubling time tried Olaparib. Now have moved on to low dose oral chemotherapy drug called Cytoxan. So far on Cytoxan I have had reasonably good PSA response and scans done in June were a mixed bag but the liver mets were slightly worse. My PSA has began to rise in June. Plan to repeat scans sometime in September. If the liver mets continue to increase then I will enter a phase I clinical trial. The trial uses a monoclonal antibody to deliver two chemotherapy agents directly to the cancer cells. I have pre-qualifed for the trial. To qualify your cancer needs to be tested to ascertain that it contains NEC-4 protein. The antibody is attracted to this protein.

    If you have no already done so you should have your tumor genetically profiled to see if there are any actionable mutations. I have done this and found none but did give the Olaparib a try anyway.

    Good luck and I wish there was more I could say to help.

    Bill Manning

  • Thanks. My genome mapping also shows no clear path. I was included in the article in New England Journal last month which strongly recommended genomic testing to benefit other family members.

  • Hi Bill,

    My husband is in a similar situation. He, too, was prequalified for his phase 1 clinical, but when he did the bloodwork prior to signing, his liver enzymes shot up beyond the trial's cut-off point so he couldn't sign up. The good news is that had he already signed the paperwork and had been "in" the trial, he would have had to be let go. Instead, they put him back on a different chemo regimen (carboplatin & oral Etoposide) with the hope of lowering the enzymes so he can get into the clinical. A chemo break was given as a wash out, but the last chemo drug (Jevtana) didn't do anything for his liver mets. My husband has multiple mutations and the clinical that he is trying to get into addresses those mutations. I wish you the best of luck and to everyone else!

  • I had carboplatin added to carbazitaxel after carboplatin was identified as likely to work for me after molecular profiling done by Caris in Phoenix on lung metastases in August 2014. The biopsy sample was stored by Caris. Carboplatin was added after two doses of carbazitaxel and the effect was very significant. Dropping PSA from 1905 to 1210 and Alkaline Phosphatase from 931 to 343 after the second dose. Molecular Profiling was arranged by Dr Charles Myers of American Disease of the Prostate in Charlottesville, Virginia. I am not currently on Lupron or Zolaxex.

  • Find out if you have a mutation in the BRACA gene, if you do one of the parp-inhibitors could help.

    Joel

  • My husband is BRCA1 positive. Olaparib was great for his bone mets, but didn't do anything for his liver mets.

  • Are liver mets hard to kill? I suppose if there are many tiny ones they would be. Is that the way they come?

  • That has been sequenced twice. I have several other mutations, but not BRACA. In fact, my genomic sequencing was included in a study published last month in NEJM which promoted genomic sequencing for prostate cancer patients. Since my mother had breast cancer in the 1950s we thought BRACA mutation was likely.

  • Please keep us informed. Ex was only diagnosed 4/15, but has already failed Lupron, docetaxel, Xtandi and now likely Zytiga. Since he is against more chemo and radiation (xofigo) I'm not sure what will happen now. He struggled with quality versus quantity...

  • I have had excellent quality of life through the chemo to date. I had both zytiga and xtandi prior to chemo. At the moment the options we are considering for next steps include a different chemo cocktail. Will be meeting with my Seattle oncologist on 8/30.

  • Do you know where the cancer is? Or cancers are?