Adding Zytiga to ADT

My oncologist believes in aggressive therapy for advanced prostate cancer. My last CTscan showed two or three likely lesions in my pelvis. That, so far, is the extent of my disease progression. I am now receiving quarterly Lupron shots. My second was two weeks ago. I was first treated with radiation therapy in 2005 (see my introductory post). The first Lupron shot brought my PSA to 1.3 from 19--a sudden spike. He is advising that I add Zytiga to my regimen. Is anyone else following a similar plan? My doctor has contacted my insurance for pre-authorization because the cost of the Zytiga pills is in excess of $9,500 per month. What will I gain from this addition? Appreciate any comments as I am a bit bewildered by all the choices.

35 Replies

  • Up until recently, Zytiga was used as a "second-line" Androgen Deprivation Therapy (ADT). It was prescribed only after the first line (Lupron or equivalent) failed.

    As a result of two recently published Phase III trials (LATITUDE and STAMPEDE) Zytiga is now being added to the primary ADT at the beginning instead of waiting until later.

    Here's a quote from an article about the LATITUDE trial:

    "Results from the phase III LATITUDE trial demonstrated that the addition of abiraterone plus prednisone to androgen deprivation therapy (ADT) lowered the risk of death by 38%. The combination more than doubled median progression-free survival (PFS) to 33 months compared with 14.8 months for ADT plus placebo in men with newly diagnosed, high-risk metastatic disease (HR, 0.47; 95% CI, 0.39-0.55; P <.0001).1"

    I'm not sure how many insurance companies are covering it before resistance to Lupron develops. They are sometimes slow to cover new treatments.

    The STAMPEDE trial also showed a similar overall survival benefit to taking 6 rounds of Taxotere chemotherapy at the beginning of Primary ADT treatment.

    That's the approach I have used.

  • Gregg57, I am so glad I've signed on this site. Information is power! I will certainly take the Zytiga if my insurance is reasonable. I will check on those studies. Thanks again for the always speedy and most helpful response.

  • For the latest study on the subject of Abiraterone acetate (Zytiga) (+ prednisolone) plus ADT (e.g. Lupron):

    "Among men with locally advanced or metastatic prostate cancer, ADT plus abiraterone and prednisolone was associated with significantly higher rates of overall and failure-free survival than ADT alone."

    Zytiga cuts off one of escape paths associated with ADT failure (CRPC).

    "A total of 1917 patients" "The median follow-up was 40 months."

    "There were 248 treatment-failure events in the combination group as compared with 535 in the ADT-alone group"

    In other words, in the follow-up period, about half of the ADT-only men had treatment failure, but only a quarter of those on the combined treatment.

    Another escape path involves cholesterol. Regardless of your LDL-C level, you should consider a high-dose lipophilic statin too. see recent thread.


  • pjoshea13, Can't thank you enough for taking the time to respond so quickly. As I've mentioned to others, I will now certainly take the Zytiga if my insurance is reasonable. Very promising statistics from the studies you cited. I have been on statins--before I was born, or so it seems--take metformin, and am revamping my diet to ward off the poundage increase. Much appreciated. I spent an anxious night trying to imagine what, why, when....

  • Check PAN (patient access network) 1-866-316-7263. For assistance with ZITIGA & XTANDI.

  • Thanks, Charlesd, I will call tomorrow. Still hoping for good news on my appeal.

  • Last month mymedical oncologist added Zytiga to the Lupron that I have been on for a year. This was based on a number of studies that came out this June showing dramatic improvements with this combination vs starting Zytiga only after Lupron fails. She stated that she thinks this will now be the standard treatment. Some background papers are listed below:

    Most of the side effects I experience come from a he Lupron (muscle loss and fat gain, lower bone density, hot flashes and fatigue). However, since starting Zytiga I have had very intense dreams. Not bad dreams, just intense. This may be the result of the prednisone that you must take with Zytiga.

    Please check with your insurance to see if they will cover it. Mine does. I pay just $22/month vs the full price of ~$9500/month.

  • May I ask what insurance you have? My husband paid $10,000 for month one. I am writing for him SIDW. He has bone cancer from prostrate. he has been taking Zytiga with Prednisone and it has far, but we can't put up that $10,000 per month any longer.


  • I live in Michigan. My insurance is from work, Blue cross of New Jersey. They have the oral cancer fairness act,which means they have to cover oral cancer drugs the same as if it was a shot given at the hospital. It gets me so made that some states fo not have it, If I had a Michigan based insurance it would not be covered.

    Please check to see if there are some programs that would help cut the cost.

    So sorry. I want to swear. It is not right.

  • Right on, Dr. Who. I will keep you posted on efforts by my oncologist to get my provider (very, very good plan so was surprised at their cursory rejection) to be me covered. Good health, stamina to all!

  • Shyr, My oncologist has sent a letter of appeal to my insurance company detailing the new studies re: ADT and Zytiga. I, too, can't afford nearly $10,000 per month. Good luck!

  • I've been on Zytiga and prednisone for a year now and my cancer is not metabolically active. I'm also getting monthly shots of firmagon, as i became resistant to lupron. ive been through just about everything. reach out if you want to talk!

  • celler6, Thanks for the information. Does the prednisone have side effects? So terrific that combo in working so well now--and for years to come. I will be in contact with other questions. Every stage brings new questions, anxieties. Thanks for sending the pharma contact site. I plan to pursue all avenues and hope the appeal with my insurance company approved.

  • Hi

    I'm one of the 1917 men in the Stampede trial. I've posted this before, but I'll repeat it for your benefit. PSA at diagnosis 600+, Gleason 7, 7 major mets to skull, shoulder, two ribs, pelvis and both femurs.

    Started on Stampede within 3 weeks of dx. That was nearly 6 years ago.

    PSA at last test was less than 0.1.

    From my point of view, a pretty remarkable result.

    Major side effect has been severe muscle wastage, which combined with the femur damage has left me disabled, but so what, I'm still here.

  • Also, contacting the manufacturer will likely give you a discount. Check it out here:


  • Zytiga is now recommended over Xtandi. Supposedly the side effects are a little less. I vote for Xtandi, same basic price as Zytiga. Fortunately for me I was in a phase 3 trial with Xtandi (enzalutimide) for 32 months until the fatigue became overwhelming. The trial paid for the Xtandi. I did try Zytiga later but lasted only 2 months, insurance covered this, but did not pay list price, they paid about $3200/month.

  • bbhot, I am hearing much the same from other men on the site. So far my insurance is balking. Will wait to hear what the appeal process with bring. My oncologist is adamant about adding Zytiga. Lot's to think about and deal with. Stay strong and fight that fatigue.

  • I'm back on ADT3 after axumin scan found a 9mm met to bone which I radiated with SBRT . Also started xgeva. PSA is down to .3 from 2.3. My ROs haven't recommended Zytiga until I become castrate resistant.


  • Bob, I think this combo is set to become the new standard but insurance companies will have to step up to plate and provide reasonable coverage. Does the radiation have side effects? Be resistant! Thanks

  • Ronton. My onc is doing the exact same treatrment with me. You will gain a one two punch in starving the cancer. Look up the Stampede trials for the dramatic results. This first line synergy with ADT and Zytiga is a 2017 protocol. My onc at MD Anderson claims he can get it approved for 67% insurance coverage. "Just do it"

  • Chucko, My oncologist's office is pressing my insurance company to provide coverage. They issued a quick denial but my case manager at Seattle Cancer Care is adamant about appealing. I am a bit surprised as my plan is exceptional. Will pursue it and plan to "Just Do It." Keep that optimistic attitude and let's keep in touch.

  • ronton2,

    When you go on Zytiga, did your doctor suggest 5mg or 10 mg of prednisone?


  • It is critical that you take prednisone with Zytiga. It's role is to help minimize the side effects of Zytiga. Listed below is an article about it.

  • Rich, I just sent that question to you. Like minds, eh. I will certainly inquire. So grateful for all this advise. How would me manage this disease without this community!

  • DR_WHO,

    Thank you for an informative article. If tolerated have 10 mg of prednisone. If not tolerated well, drop amount to 5 mg of presdnisone.


  • Rich, Does the regimen call for 10mg? My oncologist should make that decision?

  • ronto2,

    It is usually 10 mg; if you can't tolerate 10 they drop it to 5 mg. Reserch the following: I believe if you have theAR-V7 gene variant, Zytiga doesn't work. 35% have the gene variant; however, you can get tested before you take the drug. They use tumor tissue. I am trying to find out if there is a blood test for the gene variant.


  • Rich, I am a bit bewildered by all the choices and tests. My oncologist has not mentioned gene testing yet. I should ask for that before beginning --if I do--Zytiga?

  • I take 5 mg in the morning. The only side effect I have noticed are very, very intense dreams. Not bad dreams, just very real. For this reason I would not want to go on 10 mg.

  • Dr. Who, I do remember my doc mentioning prednisone with Zytiga. So many pills! As long as your dreams are intense--in a good way--that is not such a bad side effect. I will keep you posted on my appeal for Zytiga. Good health and faith.

  • Good luck! I went from taking no pills seven years ago to taking 23 pills (13 different drugs) a day along with the Lupron shot. I do not think I have to eat anymore as I could get all my nutrition from the pills!

  • I won't be too far behind on the pill count if I start the new regimen.

  • Abiraterone comes out of patent in 2 years time. Here in the U.K. It's free of course.

    I take 5mg of prednisone, a bit hard to tell if it's that or other medication, but my skin has become much less greasy, my hair much drier. Of course it could also be the ADT

  • Bad news about getting generic Zytiga any time soon. The patents expired last year (2016), but it's use with prednisone (which you must take) is covered by patents for another 10 years.

    "The administration of Abiraterone in combination with Prednisone for the treatment of mCRPC is protected by patents in the family with priority US92150606P; these patents are set to expire in August 2027 in Australia, Europe and US."

  • I haven't noticed those two side effects with ADT. But we all respond differently.

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