Zytiga in the hormone sensitive setting

[Blair77]

Today our oncologist mentioned that he had been trying to get his hormone sensitive patients to have Zytiga in place of Casodex. He said that insurance was denying everyone. He said he was certain Zytiga would work better then Casodex. So I'm thinking of buying it in Canada? Thoughts/ ideas?

[Hidden]

Do you know specifically which companies are denying it? Just curious because I will be looking into it.

[Blair77 in reply to Hidden]

He didn't specify. We have Anthem BCBS PPO. The dr. Said "all the insurance companies so far"

[Hidden in reply to Blair77]

Thanks. I'm wondering if it took a while for the insurance companies to get on board with early chemo after the trial results came out. Early chemo has petty much become the new Standard of Care for stage 4 hormone naive PCa, but I imagine that didn't happen overnight.

[Dr_WHO in reply to Hidden]

I have been on Lupron for over a year. My Dr. just added Zytiga (based on the Stampede trial results). Even though Zytiga cost about $9000/month, my insurance company pays all but $22 of it.

[Blair77 in reply to Dr_WHO]

That's great. I wonder why our oncologist acted as it would be impossible to get. What type of insurance do you have? We have Anthem BCBS.

[Dr_WHO in reply to Blair77]

The issue may be the state you live in, and more to the point, the state where your insurance is based. I live in Michigan but have (early) retirement insurance from my company which is based in New Jery. My medical is from Blue Cross of New Jersey and Caremark New Jersey for the drugs. New Jersey has the oral cancer fairness act, Michigan does not. In short, the fairness act dictates that drug coverage has to include pills and not just shots you get at the hospital. Zytiga is a pill. As a result it is NOT covered by most drug policies based in Michigan. Since my drug coverage comes from New Jersey, which has the oral cancer fairness act, it is covered.

Blue Cross of New Jersey covers my Lupron shots since I get them at the hospital or clinic. Caremark of New Jersey covers the Zytiga. If I had Caremark based on a Michigan policy they probably would not cover it.

Two fast points:

1) The need to be able to get insurance (Medical and Drugs) across state lines.

2) The need to get all states to make the oral Cancer fairness act into law.

[Blair77 in reply to Dr_WHO]

We are in CA but I'm not sure where our plan is based out of.

[herb1]

Why would you go to a drug that has a more serious set of side effects (including cost) if a cheaper, safer product (casodex) is available AND WORKS!?

HERB S

[AlanMeyer in reply to herb1]

Herb wrote: "Why would you go to a drug that has a more serious set of side effects (including cost) if a cheaper, safer product (casodex) is available AND WORKS!?"

That's an excellent question but I think it would be answered differently today from the way it was answered five years ago.

It used to be thought that the best practice was to use the drug with the lowest side effects that held down PSA. When it stopped working, go to the drug with the next lowest side effects, and so on. That sounds like common sense. However recent trials have been showing something different. It now appears that hitting the cancer as hard as possible early on with the more potent drugs gets longer lasting results. For example, the important "CHAARTED" and "STAMPEDE" trials found that a combination of ADT + docetaxel chemotherapy produced significantly longer life extension than ADT followed by chemo after the ADT failed. Even for ADT alone, without chemo, some docs are reporting better results with early Zytiga than with Lupron followed by Zytiga after Lupron fails.

I don't know why this is so. I think one theory is that drug resistance develops by mutations in existing cancerous cells. The more cancerous cells there are, the more total mutations will occur, and the faster it happens that the bad mutations occur and confer resistance. So you want to kill as many cancerous cells as possible as early as possible and achieve the smallest population of tumor cells that you can.

I don't think we should all run to our doctors and demand more powerful drugs. There may be some men, for example those with very slow growing cancers, who will do just as well on Lupron or Casodex as with Zytiga and will suffer fewer side effects. If your cancer is like a railroad spike, it may need a sledgehammer to really drive it down. But if your cancer is more like a thumbtack, a little push may be all that's needed to get the same effect (undetectable PSA.)

If I'm interpreting what I've read correctly (not guaranteed!), men with aggressive disease (railroad spikes) will do better with early use of more powerful drugs.

Alan

[herb1 in reply to AlanMeyer]

Alan, for railroad spike cancers, I think I'd agree with you. But I was writing about, and thinking about combined lupron AND casodex (maybe even with Avodart in the mix). Check me, but I think even with Zytiga the lupron is continued. Maybe I've also been a lucky one in that Lupron/Casodex has been very close to innocuous to me, as far as side effects.

herb

[Blair77 in reply to AlanMeyer]

Alan,

I think that's a great interpretation.

[pjoshea13]

Blair,

I'm puzzled why he would favor Zytiga over Casodex.

Casodex is an antiandrogen, & Xtandi is too. So Xtandi versus Casodex I understand.

"He said he was certain Zytiga would work better then Casodex."

It might, but I suggest that they would work better together.

-Patrick

[Blair77 in reply to pjoshea13]

Perhaps he just meant worked better then Mike just continuing on Lupron and Casodex alone. He didn't go into great detail.

[Hidden in reply to pjoshea13]

Patrick, I think this is because the doc is referencing the trial results from Stampede and Latitude ( ascopost.com/News/55700 ) where they used Zytiga very early, not Xtandi. However, Xtandi is also in clinical trials for early use and I believe most oncologists believe the results will be as positive as they were with early use of Zytiga, as seen in the Latitude trial.

Len

[erjlg3 in reply to Hidden]

How's the drug holiday going Len? You doing good?

[mklc in reply to Hidden]

Hi Len,

Can Zytiga be used on Intermettent basis (i.e. 9 month)

OR once you start on Zytiga does it have to be forever ie. continuous basis?

Many thanks.

[RonL in reply to mklc]

Zytiga is used continuously until it loses it’s effectiveness, then it’s stopped and you move on to the next treatment.

[John-carp in reply to RonL]

Hi

I was on Lupron for two years went on vacation and a year later PSA came back. Got to .50 and qualified for Axumin PET. The found the the cancer In pelvic lymph nodes and are doing Lupron and zytiga. For 6 months with radiation. Using zytiga intermittently was recommended. And my zytiga was covered by anthem. I got to Seattle cancer care

[GeorgeGlass in reply to mklc]

I think some MOs are trying it intermittently. It hasn't been tested in studies but I bet it will at some point, and I have a feeling it would work well because I don't think its really any different than intermittent Lupron alone, just a little stronger double pronged attack< like when armies stop after a battle to regenerate and then go fight again later.

[GeorgeGlass in reply to mklc]

I think some MOs are trying it intermittently. It hasn't been tested in studies but I bet it will at some point, and I have a feeling it would work well because I don't think its really any different than intermittent Lupron alone, just a little stronger double pronged attack< like when armies stop after a battle to regenerate and then go fight again later.

[Blair77]

Yes, he referred to the LATITUDE study.

[Charlesd]

I have posted several times to check into PAN (access on Internet) PATIENT ASSISTANCE NETWORK. For help with paying for ( or completely covering) ZITIGA &. XTANDI.

[Blair77 in reply to Charlesd]

Thanks, I will check this out.