Running out of treatment options? Thoughts?

[Bceagle]

I have bone Mets (spine ribs hips skull) and extensive disease in my lymphnodes in my abdomen that causes me to have constant stomach pain. I am on a pain patch and oxycodone when I pain flares up. I have done casodex, Lupron , zytiga , 3 chemo ( cabazitaxol, carboplatinum, Etoposide) and currently on olaparib ( parp inhibitor targeted for Brca2 gene mutation which I am positive for) I don't think olaparib is working and now thinking about the next treatment. I am tired and in pain all the time. I had blood clots in my lungs and currently on blood thinner. I am looking into a clinical trial at MD Anderson - Ipilimumab and Nivolumab combination .My current oncologist at Sloan ( Susan Slovin) does not think the current immunotherapy on the markets (provenge ) would be effective for me. Does anyone have any thoughts on Iplimumab or Nivolumab or currently on it? Any thoughts would be appreciative

[JoelT]

Ipi as a single drug is not Amy good for prostate cancer, combining it with another drug is in clinical trials so nobody can say if it would be effective.

I agree with Dr Sloven that at this time Provenge is not worth it for you to take. It needs time to start working so it is better with men who have much less disease than you.

I did not see that you have taken Xofigo nor Xtandi. I also did not see Jevtana.

Joel

[Kalegirl]

My husband was BRCA 1 and had wonderful success with Olaparib but I think it took awhile to work. His PC spread to his liver and he survived with that for 2 years. He couldn't get in a clinical because his liver enzymes were too high. As a last ditch effort, he tried Keytruda on his own but it didn't work...not surprising because his liver was so compromised. I think if given a chance, he would have entered a clinical earlier. I've heard that PCF has reported some excellent results for some people. It's a process to get into a clinical...so to think about it too long! G-d bless.

[JLS1 in reply to Kalegirl]

Hi Kalegirl, my husband, who has the BRCA (somatic) just started the olaparib last Friday and has been getting more bone pain since then. Our prostate oncologist specialist said to give it time to work, which is what it sounds like your husband experienced. Do you recall how long it was before he noticed it helping? Also, do you know how well it worked on his liver mets?

My husband became CRPC a couple months ago. He only got about 4 months from the standard therapy of Casodex, Lupron + 6 treatments of docetaxil after being diagnosed with st 4 PC - extensive mets to bones. He tried the Jevtana + carboplatin chemo when first diagnosed as CRPC, and it worked very well on his liver mets - blood tests showed his liver to be normal! -but then his platelets were too low and weren't improving enough to have any more of that chemo, so we're keeping it in our back pocket.

TIA

[AlanMeyer]

I think that Joel's questions about Xofigo and Xtandi are pertinent to your situtation. They might help regress the cancer (especially Xtandi) and relieve pain, though you will likely still be tired on Xtandi.

The clinical trial is a crapshoot, but when other options are gone it might be time to roll the dice. In a recent trial of checkpoint inhibitors on 10 men, 7 got little or no benefit but 3 got spectacular benefit with PSA dropping to 0.1, in one case from over 2,500! There could be nasty side effects from them and it's a roll of the dice on that too,

Best of luck.

Alan

[herb1]

Bceagle: I don't see plain ole docetaxel on your list of tried treatments. Did Slovin decide to just leapfrog it? Good luck. Tough road.

herb

[ctarleton]

Just to provide some additional info about ipilimumab, it failed for overall survival vs. placebo in advanced prostate cancer, and, yes, sometimes the side effects can be quite serious, requiring significant medical "rescues", typically involving lots of steroids.

"A phase 3 study of ipilimumab among patients with metastatic, castration-resistant prostate cancer (mCRPC) did not meet its primary endpoint of overall survival improvement, according to a study published in the Journal of Clinical Oncology.

Few treatment options exist for patients with castration-resistant prostate cancer. Ipilimumab, an antibody that binds to cytotoxic T-lymphocyte antigen 4, can lead to T-cell activation and increased life expectancy among particular patient groups

In this randomized trial (ClinicalTrials.gov Identifier: NCT01057810), researchers enrolled 602 chemotherapy-naive patients to receive ipilimumab or placebo.

Among the 399 treated with ipilimumab and the 199 given placebo, median overall survival was 28.7 months and 29.7 months, respectively. Median progression free survival was, however, superior in the ipilimumab arm, at 5.6 months versus 3.8 months in the placebo arm.

Nine patients died from a treatment-related adverse events with ipilimumab.

The authors conclude that while the drug does not improve overall survival among patients with mCRPC, ipilimumab does show some anti-tumor activity, and should be studied further to establish which patients are likely to benefit from its use.

Reference

1.Beer TM, Kwon ED, Drake CG, et al. Randomized, double-blind, phase III trial of ipilimumab versus placebo in asymptomatic or minimally symptomatic patients with metastatic chemotherapy-naive castration-resistant prostate cancer. J Clin Oncol. 2016 Oct 10. doi: 10.1200/JCO.2016.69.1584 "

[AlanLawrenson]

A new treatment that is approved in Australia (where I live) and in Germany where 10 or more major hospitals do the treatment using a Lutetium -177 radioisotope called Lutetium-177 PSMA Therapy uses a molecule which attaches itself to the PSMA receptors on the cancer cells. Before it is administered, the PSMA molecule is bound with Lutetium-177, which emits beta radiation, a destructive type of radiation that damages the cancer cells when it is in close proximity to them. Over time, it destroys the prostate cancer cells. The PSMA molecule acts as a means of transporting the radiation to the tumour site, so that the whole body does not get exposed to the radiation. This is often referred to as Peptide Receptor Radionuclide Therapy (PRRT).

One of the research groups that have pioneered this technology is based in Perth, Western Australia, where they have treated more than 150 advanced cancer patients. They will start to offer Lutetium -177 PSMA therapy at the Macquarie Hospital in Sydney, Australia later this month.

My brother will be one of their first patients.

Additionally, the Peter MacCallum Cancer Institute in Melbourne, Victoria, Australia, recently recruited men for a clinical trial that is about to begin shortly.

A clinical trial has just been announced in the USA.

A number of smallish trials in Germany have reported what I have interpreted as excellent results. A little more details in my free newsletter ProstateTalk available at anabcofprostatecancer.com.au. One downside is that is an expensive therapy. My brother is trying to get his medical fund to contribute to his costs.