First line therapy changes

[leswell]

Zytiga/Prednisone plus ADT after Chemohormonal Therapy

The “New England Journal of Medicine” on August 20, 2015, recommended early “Chemohormonal Therapy in Metastatic Hormone-Sensitive Prostate Cancer.” Slightly under two years later that recommendation has changed. On June 3, 2017, it printed the following trial conclusion: “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. (Funded by Cancer Research U.K. and others; STAMPEDE ClinicalTrials.gov number, NCT00268476, and Current Controlled Trials number, ISRCTN78818544.)”. In short, ADT plus Zytiga/Prednisone is now recommended instead of Taxotere, etc. + ADT as the first line of treatment for metastatic PCa.

As some of you know, my husband’s diagnosis was April 15, 2016, and his treatment was based on the 2015 recommendation. The studies resulting in the second hadn’t yet been completed. Some of the side effects of his treatment are bilateral lymphedema, fatigue, muscle loss, gynecomastia, and memory loss. I would say he “fell in the crack” between the two recommendations. I doubt he would have experienced all of those side effects from Zytiga.

My primary question today is whether the fact that a patient had early chemohormonal therapy lessens the overall survival benefit of the 2017 recommended Zytiga/Prednisone + Lupron (or Firmagon). My second question/complaint is that cost of the latter combination varies from manageable to impossible for most patients, i.e. from $22 to $9500 per month! Why, if the evidence of the most effective current treatment is so apparent, must patients and doctors have to try to negotiate a lower price? In short, do only the rich or famous get an extra few years of life?

———

P.S. On a much lighter note a P.S. to Nalakrats. The Cal/Mag tablets arrived yesterday, but they’re nigh unto impossible to swallow! We’ll dissolve them in water and hope for the best. They do have added Phosphorus but chelated isn’t mentioned anywhere.

Here is a link that will give most of us a smile, I hope.

npr.org/sections/health-sho...

P.P.S. Our brother who died of brain cancer (Mayo, 2002), signed off “go well”. “Go better” will have to do for you and for us. Wellness would be swell, but that horizon is likely as much a mirage for those of us in Stage Four as was the view from the Titanic.

Leswell‘ s spouse since 1962–hey, 55 years ago tomorrow. Time to celebrate all of those good years, minus one.

[Sisira]

This is very personal. I have a feeling that the combination early chemo plus ADT should work better because chemotheraputic drugs are cytotoxic ( killing cells ) and thus are capable of destroying even the hormone insensitive PCa cells whereas all hormonal drugs and antiandrogens such as Zytiga and Xtandi can only suppress the growth of PCa cells. There can be ulterior motives and vested interests in pushing Zytiga for early use because through its unbelievable price the drug companies can amass colossal profits. God only knows about the credibility of these so called reputed trials when their recommendations completely disregard the pricing of drugs that itself will kill many cancer patients!

I do respect honest research, honest trials and honest treatments .... no doubt.

Sisira

[leswell in reply to Sisira]

Sisira, Thanks again. Sorry but you have to scroll down to find my reply to you.

[TommyTV in reply to Sisira]

In the U.K., all treatment is free. The Stampede trial in the U.K. Is free. There was and is no vested interest here in the U.K.

I am one of the 1900 in the U.K. On Abiraterone and the results have been incredible for me.

[Hidden in reply to Sisira]

I think you missed a word.

You said "whereas all hormonal drugs and antiandrogens such as Zytiga and Xtandi can only suppress the growth of PCa cells. "

And I am sure you meant " suppress the growth of PCa cells that are still sensitive to testosterone. " So abi/enza would not kill any ARv7s for example, whereas chemo could. And some PCa is said to be able to locally create testosterone out of cholesterol or other steroids, and/or that other steroids, rather than jam the AR, eventually will cause it to operate.

The initial problem is said by some (Denmeade) to be that the PCa eventually adjusts to low levels of testosterone, by muliplying the count of ARs in the cell. So a better treatment option may be the rapid cycling of testosterone levels. The best length of the cycle is not known, but possibly could be determined in the laboratory in a dish. [dont you think?]

I am sqeemish about abi/enza because of the possible progression to small cell (or neuoendocrine) type of cancer, which is frontierland.

[Sisira in reply to Hidden]

You are very correct Martin.

Sisira

[gusgold]

Nal,

most guys could not swallow 2 cal/mag tabs plus 12 other pills at once like you.....the huge maw you developed as a side effect of Gator Blood gives you the ability to down a hand full of pills at once

vignette1.wikia.nocookie.ne...

Gus

[gusgold]

Leswell,

If your husband does not have mCRPC there is no reason he could not try ADT+ Zytiga

Gus

[leswell in reply to gusgold]

The last shall be first. Thanks for making us laugh on our anniversary. You’re all just the greatest. Well, the PSA is coming down. Back to 96 but a fur piece to go to get to 2. Why ever did we agree to intermittent? We decided to suspend estradiol patches yesterday. I don’t think Leswell looks as well on those. My humble opinion. I have a refrigerator full of broccoli from our garden which should pair well with champagne of a rare vintage, i.e. Kirkland.

[Hidden in reply to leswell]

What was your experiennce with estradiol patches?

[j-o-h-n]

I don't have any trouble swallowing pills but I do have trouble swallowing my ex-wife's bullish!t...

j-o-h-n Thursday 08/03/2017 9:50 AM EST

[leswell in reply to j-o-h-n]

Perhaps I should shut my own mouth for the remainder of “our” day.

He’s out checking out the Japanese Beetles to see if they’re still out in the rain.

Cheers everybody. Hope I didn’t reply to the wrong writer. Mrs. S

[leswell]

Very funny. I tried unsuccessfully to dissolve the tonnage in orange juice this morning. Next will be the mortar and pestle since we won’t be going to the drugstore today. I guess the primary reason Leswell is not on Zytiga yet is $s. Also, his oncologist has not recommended it.

[leswell]

Thanks. His BP is 120/80. MIne is through the roof. I’m taking them for sure. Mrs. S

[leswell]

I respect YOU (and your family). Thanks. Aren’t you the runner? Les was, too. 10,000 mi to and from school and seconds from qualifying for Boston in his forties. Yes, I’m proud. No running with lymphedema though. Lots of gardening. (4300 sq ft, lots of cruciferous). Mrs. S

[j-o-h-n]

You did.... but no problem... It's like when I went to my Shrink and he asked me "what's my problem?" I told him "I don't know Doc but everyone seems to ignore me" He said "OK NEXT"....

j-o-h-n Thursday 08/03/2017 10:29 AM EST

[leswell in reply to j-o-h-n]

Oh no. I see that. Patience and time. I’ll get this site figured out before we depart the planet. If you only knew how apt your shrink joke is.

Having never missed a day of school due to illness, these multiple doctor visits are like a trip to...Sri Lanka? Leswell(s)

[DFZ4835]

The cost of Zytiga is huge but if insurance picks most of it try foundations like HealthWell, Patient Advocate Foundation and Patient Access Network. These foundations may pick up the unpaid portation. All are based on verification of income. Their help are for us that don't have a large income. They are not based on poverty levels but more realistic income. I hope you find this useful.

Dennis

[leswell in reply to DFZ4835]

I’ve saved those sources. Thank you!

(Not sure my last thank you “went”.)

[TommyTV]

I've been on Zoladex + Abiraterone + Prednisone for the last nearly 6 years as part of the 1900 or so of us here in the U.K. On the Stampede trial.

PSA at dx was over 600, 7 major bone mets.

Apart from weight gain, severe muscle loss in my legs which combined with the mets in my femurs has left me somewhat disabled, I'm in pretty good shape for someone given 6 months to live!

Glad I didn't blow all my pension money at diagnosis...

[leswell in reply to TommyTV]

Your story is a triumph and such an encouragement for us. Thanks for your reply. What comes next for Leswell is more uncertain because, although very fit, his PSA was 1500 when diagnosed. He has already undergone chemotherapy as I reported elsewhere. We’ve just had a joyful, pain-free day and trust you have too. Mrs. S

[Hidden in reply to TommyTV]

1. I presume you see the bone mets as the major threat, since you need your bones to create blood cells. To what extent have you considered local radiation of the bone mets and/or bone marrow transplant?

2. Have you considered estradiol patches to counteract bone and muscle loss (with blood thinner??) and/or occasional testosterone injection?

Congrats by the way.

[TommyTV in reply to Hidden]

To be perfectly honest, I've gone by the book with my Oncologist regarding treatment. As everything is free here in the U.K., we don't really have the choice that private health insurance provides.

As I've done so well on this drug trial, I don't want to add in anything that might affect trial results.

The bone mets are of no consequence, I have them, I live with them, occasionally one of the rib mets antagonises the muscle in my back, and my femurs are pain free but a nuisance.

I enjoy that other well known testosterone suppressant, alcohol, if I feel like it, although walking becomes somewhat like the Aliens in Galaxy Quest, or if you want a laugh, look up "two soups" on YouTube. That's me!

I own my own media business and still work 5-6 hours most weekdays.

I'm over cancer getting me down, I live with it, it's a bloody nuisance at times, but I still enjoy life.

Onwards and upwards!

[leswell in reply to TommyTV]

Good talking to you. I’ll check in later to see how you’re doing. Most of my life has been intentionally grounded except for flying Pan Am to London twice in 1960 heading to and from Beirut where I studied for a semester. Even played the piano for a college version of “The King and I” while there. Most challenging and fun was helping fellow students from numerous Middle East countries sing the musical in English. On my own at age 20, I managed to find a home In London for an overnight before returning to the U.S. The family couldn’t have been nicer.

We both wish you more years enjoying life. I’ll be sure to look up “two soups”. Smiling already. Mrs. S

P.S. I loved my philosophy of religion teacher, Ms. Gray, the president of the Beirut College for Women and pretty much memorized the assigned text. Trueblood, I think.