Zytiga + ADT (pre-CRPC)

[pjoshea13]

New study below.

Seems a bit pointless to do a meta-analysis at this stage, but the paper is open access, so we get to see details that do not appear in the STAMPEDE & LATITUDE Abstracts. The link is to the full text.

-Patrick

sciencedirect.com/science/a...

[BigRich]

Patrick,

Thank you!

Rich

[Hidden]

So, Conclusion.

"Adding AAP to ADT is a highly effective treatment option for men with mHSPC and offers an alternative to docetaxel, for men who are starting treatment for the first time. Future research will need to address which of these two agents or whether their combination is most effective, and for whom.

"

It appears that a person can take Docetaxel later rather than sooner. This is nothing new. This study suggests that a man starting treatment can/should use Zytiga right off the bat. The research on this subject needs a lot more study. All this study has done is change the sequence of treatment. You can start the show with Lupron and Zytiga or Lupron and Docetaxel. Personally I'm glad I started with Lupron and Docetaxel. I have read on many posts men becoming to weak to tolerate Docetaxel, but could tolerate Zytiga.

Researchers need to present new drugs, not mix existing drugs in order of battle. Studies have shown (can't find the source) that the most effective treatment against metastatic sensitive prostate cancer is Docetaxel. That being the case, why wait? Using Zytiga to start the fight should be reserved only for men who CAN NOT tolerate Docetaxel.

Personally I'm tired of these studies that give men false hope. Of course what do I know? I couldn't properly dissect a frog in school. I do know one thing however and thats when the medical profession is playing the shell game with patients.

[pjoshea13 in reply to Hidden]

When I was diagnosed, options hadn't changed in a number of years & didn't until fairly recently. Pharma got fast track FDA approval for Zytiga & Xtandi on the basis of some benefit in CRPC cases that had failed Taxotere. But doctors were left wondering about the best (off-label) sequence/combination in those who had not run out of road.

Naturally, BigPharma would like to see expensive drugs used earlier - bigger populations & potentially more months of treatment per man.

It was something of a surprise that Docetaxel did so well in the CHAARTED study, when used up-front with ADT. It has been around for 20 years & had been considered lackluster. It seemed that if Taxotere was in one's future, it would be best used early (with ADT). Seemed to complicate the question of when to use Zytiga & Xtandi..

However, the survival advantage was only seen in those with high-volume disease [1]. So for low-volume metastatic or non-metastatic disease, Taxotere does not seem to be a natural up-front option.

-Patrick

[1] journals.plos.org/plosone/a...

[Hidden in reply to pjoshea13]

Patrick,

Your link provides the following information.

"The combination of docetaxel and ADT increased the clinical progression-free survival, bPFS and OS in patients with mHNPC (defined by the presence of visceral metastases or four or more bone lesions with at least one beyond the vertebral bodies and pelvis).The overall survival was especially higher for patients with a high-volume disease. This regimen may be offered as a first-line treatment for selected patients."

When I was first diagnosed, I had three bone lesions with none beyond the vertebral bodies and pelvis. Therefore looking back I wasn't considered to have a high-volume disease according to the quote above. However, several internationally renowned prostate cancer doctors urged me to begin Taxotere immediately.

You stated "So for low-volume metastatic or non-metastatic disease, Taxotere does not seem to be a natural up-front option". With all due respect, what do you base this statement on? Please help direct me to the data showing the early use of Taxotere and ADT does not benefit men with a low-volume metastatic diagnosis. Did I make a mistake regarding treatment choices?

I'm not the brightest candle on the cake, therefore a direct link showing that the early use of Taxotere and ADT does not benefit men with a low-volume metastatic diagnosis would be greatly appreciated.

Thank you!

[pjoshea13 in reply to Hidden]

I don't know that there is anything else to go on, apart from this & the actual CHAARTED paper.

The conclusion was a generalization. On average, high volume guys saw substantial benefit, whereas low volume men did not, but you can't really draw a line with no benefit below & substantial benefit above.

Your doctors urged you have treatment. They would have been aware of the study details, & clearly expected you to benefit.

I don't think you made a mistake. And there was no survival downside.

The point of my reply was that while early Taxotere can have substantial benefit, some men did not experience that & might have done better on Zytiga + ADT.

Best, -Patrick

[Hidden in reply to pjoshea13]

Patrick,

A sincere thanks for the reply. However at best I agree to disagree with your statement "So for low-volume metastatic or non-metastatic disease, Taxotere does not seem to be a natural up-front option". Conversely, everyone has a right to an educated opinion and although I disagree with yours, I respect and appreciate yours posts and I'm quite sure most members at HealthUnlocked regard your opinions as a valuable asset.

[rococo in reply to Hidden]

There are differences of opinions even among the best oncologist. Certainly we can not only tolerate but welcome our own. Best regards. Rocco

[Hidden]

I asked my doctor if she could provide a source for some guidance regarding using early Zytiga after early chemo. She had told me during an appointment that at an ASCO presentation this year it was recommended that patients who had already done early chemo do not take early Zytiga. She sent me a link to article that provides a little bit of insight, but doesn't address the issue directly.

cancer.gov/news-events/canc...

Here's a part of the text:

One consideration will be the side effects of the two agents. However, comparing side effect profiles between docetaxel and abiraterone is an “apples and oranges” comparison, explained Dr. James, because docetaxel treatment is short-term and abiraterone is given continuously for years.

“Docetaxel is associated with more side effects, including infrequent but serious side effects such as febrile neutropenia and neuropathy. But most of these side effects are often reversible,” and the drug is given in six infusions over only 18 weeks, added Dr. Madan.

Long-term abiraterone use has been associated with increased hypertension and liver toxicity over time, and the accompanying prednisone could also produce long-term side effects, such as reduced bone mineral density, he continued.