Advanced Prostate Cancer
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What's next after Taxotere if treatment does not respond?

I just finished my 4th chemo treatment with taxotere. The third treatment stopped the PSA from climbing at 126 but I just got the results for my PSA and it climbed to 143. Has anyone experienced this and if so, what other chemo treatments are out there if taxotere is not working. I have heard of Jetvana and other drugs.

Thanks,

Lou

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From what I've read, Jevtana (cabazitaxel) is the preferred second line chemo if the cancer becomes resistant to Taxotere (docetaxel). A good percentage of patients respond well to it. I'm suspecting that first and second line ADT has already failed.

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If my experience is anything to go by, there are a lot of treatment options to try after taxotere. I had Taxotere three months after diagnosis in 2015. Since then, PET scans continued to show cancer in my pelvis and lower spine, so I've had immunotherapy in the form of Provenge, conventional radiotherapy, and am currently on dose 4 out of 6 of Xofigo (injectable radium). Meanwhile I've continued on Lupron and progressed from Casodex to Xtandi and now to Zytiga. In my case, I don't produce much in the way of PSA, so PSA is a poor marker for changes in cancer growth and spread. I've had PET scans some weeks after each of the above treatments instead. When these show new hot spots, my oncologist is ready with another treatment. He says we haven't begun to run out of new treatment options. So , like many others on this forum, I think your best line of defense is a caring and knowledgeable oncologist who keeps abreast of available treatments. I've learned not to worry about "what if" and "what's next". It gets in the way of enjoying life. We really do get only one day at a time.

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Thanks for you response. I have had nuclear bone scans and have not shown bone met but I heard for patients with bone met, Provenge is the treatment of choice. My Oncologist also agrees that scans are more predictable than PSA in my situation although I would like to see it go down. I do have faith in my doctor and also my creator and like you said, "We really do get only one day at a time".

God Bless

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And God bless you, too. Stay in touch.

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LP16, you did not say if you had Lupon, or other androgen therapy. That is one of the two approaches: 1) chemo against dividing cells. 2) ADT against prostate cells.

If both lines have been ineffecctive, then look for a clinical trial that targets the DNA-binding-domain of the androgen receptor.

The immune path is a third one, but has had relatively small effects for the most part. Promising, but not really dramatic yet. Not like Jimmy Carter.

Not a trial, but something EPI-506 @19:45 in

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Thanks for your reply. I have had Lupron, Trelstar, Xtandi, Zytiga, Prednisone, Calumide and first go around with Taxotere. Today I get my second treatment of Cabazitaxel (Jetvana). My oncologist also sent a tissue specimen of the lymph node tumor to Foundation One. I should get the results soon to see what type of prostate mutation I have that is very aggressive and does not respond to Androgen or testosterone deprivation. The good thing is that I am not experiencing any pain at this time since the prostate cancer spread to the lymph nodes around my bladder. I would assume that if it continues to grow and spread to other areas if not in check, I would definitely start experiencing different types of discomfort.

I am very interested in CAR T therapy from what I researched and will be discussing with my Oncologist today.

Best Regards,

Lou

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Have you checked if it is the neuro endocrine (or "small cell") variant?

This is a growing subset of post enzalutamide /Xtandi patients. I am not aware of any CAR-T therapy for prostate cancer. Provenge is the closest, but does not seem to be called CAR-T. Not sure why. Provenge is sorta weird; people dont seem to understand it. It works clinically, but your mileage may vary. If it is NES (neuro endocrine), Duke University has a trial going for prostate cancer, and U of Iowa may be helpful for Neuro Endocrine in the general setting. They are trying a treatment from Europe. Got a big grant ayear or so ago.

clinicaltrials.gov/ct2/resu...

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Thanks, I will check to see about the neuro endocrine variant and also the clinical trials.

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NP. I didn't look too closely at the clinical trials that came up, so these may or may not be of interest. But it does pay to look here, and at lease get ideas of what might be available, or to learn to names of therapies that are being tried in related situations.

I didnt see Duke in there. Maybe I can find the reference for it. Probably was in a video by Dr Antonarakis. I've watched a bunch of his lately.

I might be wrong about Duke. They are testing 3 ARV7 assays. That's different.

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News of grant to U of Iowa for Nuero endocrine:

uihc.org/neuroendocrine-spo...

Also called "small cell" and possibly related to "cribiform". I am not clear on that as yet.

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Hard to tell what is happening from one number. I would not give up on the Taxotere based on just the PSA from one test. The PSA numbers jump around and don't necessarily go down smoothly. they eventually will settle down at a constant level. I am on Taxotere and Carboplatin for over a year and while the blood markers including PSA jump around the trend has been in the right direction. More important how do your bone and CT scans appear. If they show improvement then you are really doing good. If not then you need something else.

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