This post is prompted by what @motosue had said about his meds. Apparently, he takes both Z and X.
I was under the assumption that it was one or the other. When one failed, we could jump to the other. I was denied X, but approved for Z. I assumed it was a cost factor.
Input anyone?
Joe
I'm not on either yet, but my uro did suggest that it was one or the other. He proposed Xtandi as having more favorable outcomes than Zytiga.
BTW, cfrees, I highly advise having a medical oncologist help you with this decision when the time comes. It's fine to know what your uro thinks, but Xtandi & Zytiga are squarely within the expertise of med oncs, not uros.
Strongly agree. At urologist is not a medical oncologist.
Zytiga worked for about 8 months or so...Xtandi did not
X and Z block two different pathways, so yes it is more of a complete blockade, I too was on this protocol for years , You must have very first rate insurance to get them to pay for this as I think it approaches 20 g a month. After 2 or 3 years, I was sleeping 10 or 11 hours a night , due to the added fatigue, but it worked well. Not that I was sleeping straight through , I get up every 2 or 3 hours all night.
In the end, I was eating with the zytiga to increase absorption and dose I would never do this without a DRs. supervision and advice as the company recommends against it,. DR Glode who is a great researcher of these drugs has told me he has seen a antiandrogen withdrawl symptom after a long time on zytiga whereas like bicalutamide it can turn around and feed the cancer
Dan, about the withdrawal symptom: Do your PSA results or scans start to spike or show new mets while you're still on Zytiga, or when you stop? What did you do to combat this problem?
I've had over 2 1/2 good years on Z, but my PSA is rising now (still nothing new on scans), so I'm pushing the Z closer & closer to meal time. If it goes up this month, I'll be at meal time. I'm sure you know this, Dan, but for anyone who doesn't, you need to have your liver function lab tests closely monitored when not waiting 2 hours after a meal to take Z--which is actually what should be done even when you are waiting 2 hours, but it's even more critical. Eating with or closer to taking Z increases both the medicinal effect & the danger of side effects.
Neal , How fast is your psa rising, The antiandrgen withdrawl would mean it is causing psa on a steady rise while talking the med, and stopping t would actually decrase psa, I had this experience recently stopping estradiol patch, it does not last , and probally just better to try something different. I not so much talking about little bumps up that are followed by decreases in psa, as is also seen with zytiga,If you are getting a steady rise, maybe see if your Dr can approve you for xtandi.
I was taking the full dose of Z with a high fat breakfast, and my liver numbers remained at the lowest end of normal the whole time. Way Back when I went to see snuffy, the only time, and he put me on triple dose (150 mg) bicalutamide/casodex and it sent my liver numbers through the roof, since then I have been over 2 yrs on High dose ketoconazole, 4 years on zytiga and my liver numbers remained at low end of Normal, For many of those years I continued with ursodiol which Snuff used to prescribe in those days for a liver protectant, but in recent 3 years have not done it. And liver is fine.
Neal, My numbers did spike a few times over the last 2 or 3 years, and sometimes they came back down, My local Oncologist said she had never seen anyone put off chemo for so long, almost3 years from the time I had a sharp spike from the 25 range to 40 and she called to say she thinks we should start chemo. I am on chemo now , 2 cycles out, hair gone already, no biggie , I just wear a hat. but though I feel no different, I now with a scraggly bald head, look like I have cancer, I noticed not so many people saying , but you look great Ha Ha.
Average US price without insurance or rebates for Xtandi is $10600 per month and for Zytiga it is $9988 per month. No real difference. I was on Xtandi for 31 months when my PSA started to rise and my fatigue became extreme, so I went off of it. Then I had PROVENGE treatment, then a Phase 1 Clinical trial, which I failed due to liver injury (high ALT and AST). I have now been on Zytiga for a month. PSA has stopped rising and fallen a bit. Will continue this treatment until PSA has settled. I didn't pay for Xtandi, since I was on a phase 3 clinical trial. My insurance is paying for Zytiga except for a minimal co-pay. Five years ago, when I started treatment, the general oncological philosophy was serial treatments. Now a days, parallel treatments are (more than one protocol at a time) likely, especially with non-aggressive PC. I have not seen both X and Z simultaneously in any of the medical reports or abstracts. My oncologist indicated Zytiga typically has more side effects (you need to take low dose prednisone with it), in particular for the adrenal glands. Also, it is reported in some medical reports that only 20 to 25% of patients have success with the 2nd drug (Z after X or vice versa). Everyone is different, just as everyone's cancer is different.
P.S. pricing is off the internet, Canada pricing is half the US prices.
Best of luck to you!
As far as who reponds I was not supposed to respond to z after over 3 years on High dose Ketoconazole (HDK) , but I did and better than average, so bottom line , one never knows what will work in some and not others , sometimes the oncologist are amazed. And sometimes it is worth it to rechallenge with a drug that worked in the past for us, especially when options get low. I want to keep in the fight.
Same for me...doc said "Zytiga first then if that fails at some point, then Xtandi."
Crazy huh? Four months is just a blip in a lifetime, but I'll take it when needed.
WHOA! BE CAREFUL. IS THE INCREASE IN LONGEVITY AN AVERAGE OF 4+ MO OR A MEDIAN OF 4+ MONTHS? cAN BE BIG DIFFERENCE. THE LATTER MEANS THAT 50% OF THE GUYS USING Z AND THEN X LIVE MORE THAN 4+ LONGER...AND CAN BE MUCH LONGER.
Ah yes. The average guy lives 4 months longer, so the median length is 4 months.
I read a bit more into it, and it's about idiotic. One drug says it worked in the actual drug arm for 44 months, while the placebo group got 40 months on sugar pills. Thus, the four month median.
I'm no numbers cruncher, but this sounds like BS to me.
yea, not thrilling
I was on Z for 20 months then psa began rising. Now on X and after 45 days my psa has dropped 5pts down to 33!! My med onc gave me the choice which one to use first. I picked Z as I was afraid of the printed side effects of X. I experienced no side effects other than a general light fatigue. I've not heard of both being given simultaneously. I agree with others you are past the urologist stage. You need to see a medical oncologist.
NEAL: WHOA! BE CAREFUL. IS THE INCREASE IN LONGEVITY AN AVERAGE OF 4+ MO OR A MEDIAN OF 4+ MONTHS? cAN BE BIG DIFFERENCE. THE LATTER MEANS THAT 50% OF THE GUYS USING Z AND THEN X LIVE MORE THAN 4+ LONGER...AND CAN BE MUCH LONGER.
HERB S.
Hi Joe,
I was fortunate in that I have a medical oncologist who is willing to go to bat for me and write letters or make the necessary telephone calls to convince my insurance company to provide me with the needed medication or treatment (Provenge). I was on X and Z for one year. I had to reduce (cut in half) the Xtandi because of rising liver values (AST). My oncologist's rationalization for using both drugs is that anything that might help in "confusing" the cancer might be effective (In the March edition of Dr. Meyers' Prostapedia, he has a forty minute lecture on mixing medications and treatment modalities). The X-Zcombo+Provenge seems to have worked for me for over a year, keeping my PSA in check. Next week, I see my oncologist, and that could be a different story!
I don't think taking both x and z at the same time is advisable. If one fails then go the other. I'm not even sure giving both at once is advised by the medical community. Definitely get a second opinion.
Are you going on your 25th year in fighting this disease?
Rich
Yes, I am quite aware that the cancer will always find a work-around any ADT treatment. So it is always good to use one treatment at a time. That is how I have lasted 25 years.
There was a man in the literature who made 39 years and was still alive. I hope you have at least another decade.
Rich
Me too, I didn't think I would reach 70. If I reach 80 it's time to celebrate.
My med onc put me on X because he was concerned about the steroid side effects when you take Z. Knock on wood I've been on it since September. I've been through all of the meds and ADT drugs, chemo, RSO, and radiation. I didn't do well with the ADT drugs so I went through a bilateral orchiectomy. I felt much better afterwards. A big suggestion......All of these drugs attack your liver. Take a hefty dose of milk thistle everyday. An unhealthy liver affects your health, your immune system, and ability to heal from the chemicals they feed us. My liver numbers have remained very strong through all of this.
Hear what Dr. Myers said about combining, in 2014:
askdrmyers.wordpress.com/20...
-Patrick
Thanks Patrick, debate settled. I guess?
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