No end to Docetaxel?

After a stage 4 diagnosis at end of July, MO immediately started me on lupron, short term casodex for the flair (now done), zometa for bones, and docetaxel for chemo. My initial PSA was 11.5 and mets had already spread extensively in spine. Now after chemo round four today, PSA is already down to 0.3 and im feeling pretty good. I asked MO how many rounds we were planning - he essentially said we will keep going on chemo as long as i can take it and as long as its working. Im only 55 and besides some fatigue, am doing ok. So my question is how many of you are on docetaxel for "as long as we can"? And what number round are you on? Does it physically get harder? Or just steady state as it is now for round 4?

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  • I just finished round 13. I am on Docetaxel and Carboplatin. I will be on it for as long as it works. Gets better after a while but the fatigue still is troublesome particularly after the steroids given at the time of Chemo wear off. I usually feel much better a week after the Chemo session.

  • Glad to hear it stays pretty much the same. After 4 rounds i feel like i have the hang of it. Glad its still working for you! How far down is your PSA? I saw from your profile that you were diagnosed with low PSA. My diagnosis was at 11.5, but i had been seeing a urologist for the past 3 years for retention issues and had been getting tested often. He missed my diagnosis because my PSA was low. 2 months prior to my stage 4 diagnosis my PSA was just 2.9. So those last 2 months it went up fast.

  • Should add I was Dxd @ 200.

  • PSA has moved down very nicely after it flared up last year. It has continuously moved down to 0.42 now. On the fatigue issue, after some of the infusions I feel well and after some I feel very weak. I am not sure why the difference occurs but it seems to be the case.

  • My PSA was only 2.7 at diagnosis. The DRE is what revealed the problem. Had you been getting annual DRE's ?

  • I had urinary sypmtoms for 3 years. Had been seeing the same urologist for those years with 3x a year visits. He did a DRE on visit 1 on year 1 and then never did it again. He was only giving me PSA tests and prescribing flomax, and telling me I am ok. Even after mentioning my back pain, no DRE, no discussion on biopsy, just continued PSA test telling me I am fine. Finally diagnosed through ortho who told me what i had by just listening to my back pain symptoms. Then confirmed by MRI and then back tumor biopsy. You can imagine my anger at that urologist. My wife insists that we sue, but its a gray area with low PSA when they miss it. There is a 2 year statute of limitations here in texas, so for now im just focused on treatment.

  • On the bright side, after 4 rounds of chemo i can pee better than ever!

  • I get angry at stories of medical malpractice like this. I changed insurance and had to nag my new doctor to perform the DRE. I can see general practitioners who might, like their patients, have a bit of reluctance for this test, but a urologist? Never. A urologist who is squeamish about performing a DRE is a lousy urologist. In the year I was dx'd I got a DRE from my primary care physician, a DRE from the first urologist I saw, a DRE from the 2nd opinion urologist I saw, and a DRE from the radiation oncologist I saw. Absolutely no excuse for a urologist treating a patient with the symptoms you presented to not perform these tests. In my experience and opinion there is no gray area. Period.

  • Yes, the what-if certainly hurts when Im 55, two kids under 5, and in bad shape. Plus, i am always been a hypochondriac and i was careful to follow up often. The rub is that i didnt know anything about prostate cancer to know that i wasnt getting good care. So now i focus on spreading the word, so men can protect themselves when docs dont. Anyway, im sure im not the only one.

  • You are right. There are a number of others on this site who didn't received good early treatment. At least you are on the right track now. Good luck.

  • I just had docetaxol 12, 2 weeks ago. I am 11.5 years out with stage 4, I am surprised they would put a new guy on endless chemo, Then again I do noot know anything about your case , and your MO does. Many will just do 6 cycles, but I am no Dr. I do want to suggest being followed by a MO that specific to Prostate Cancer and only Prostate Cancer, usually found in Acedemia, In such places as Major Cancer centers associated with a medical teaching College . I am glad you are doing well through 4 cycles, for me 6 was a hard one for side effects , but it seemed to get better after that, I am doing well also with the side effects, keep us posted on your progress.

    Dan

  • I was suprised as well, but the doc explained that my disease is very extensive and since im responding they want to ride it for as long as possible. I will say that my MO is an all-star and im comfortable with his experience.

  • Keep a close on your white blood count and absolute neutrophil count. If your ANC count drops below 1.0 and doesn't recover, discuss Neulasta with your MO. I speak from personal experience, however I have NO training in the medical field.

  • Yes! I am chemo sensitive and 7 days after treatment i need Nuelesta shots. Usually i get one two or three days in a row until the count is back up. At first it was very painful, but i read here to take clariton and it made 100% better. My MO has lightly suggested i move to weekly treatment (lower dose) to help with the count issue. BUT i like my 21 day cycle and essentially for the last 7 days feel great and dont have to go in for checks and my energy is good. I want to avoid weekly sessions and the fatigue even if my counts would be more stable.

  • Also, pay attention to the neuropathy. That is often the limiting factor in Taxotere chemotherapy cycles. It tends to be accumulative.

  • Guys, I am trying to relate to your Taxotere chemo treatment. You write of cycles. I see everything from 6 to 15 to endless. Please help me relate.

    I underwent a six month chemo trial fourteen years ago and was able to stop Lupron seven years ago and remain undetectable.

    How long is a cycle? What dosage are you taking per cycle? Is a cycle one infusion? Are you taking any other drugs with your chemo?

    I was given three courses of chemotherapy as explained.

    Each course of chemotherapy lasts for 8 weeks.

    In weeks 1, 3, and 5 with Adriamycin (Doxorubicin) 20 mg/m2 as a 24-hour intravenous infusion on the first day of every week in combination with Ketoconazole 400 mg orally 3 times a day daily for 7 days.

    In weeks 2, 4, and 6, treatment consisted of Taxotere (Docetaxel) 100 mg/m2 intravenously on the first day of every week in combination with Estramustine 280 mg orally 3 times a day for 7 days.

    In weeks 7 & 8 no treatment is given.

    I also took 30 mg of Prednisone daily for the six month period. Zofran was nausea and Dexamethasone the day before, of, and after the Taxotere infusion.

    BTW, your dosage of the two chemo drugs depends on your body size area.

    A drug dosed at 100mg/meters squared is (100mg for EACH square meter): To calculate your dosage use this formula adding your body size/weight expressed as a squared meter, then solve for X.

    100 mg/1 meter squared = X mg/ __ meters squared

    Keep kicking the bastard,

    Gourd Dancer

  • I was put on 10 cycles. Had no problems and good results but when I asked for more my Oncologist told me no, in common with UK practice. Throughout I had Zoladex. Then a 5 month break from Docetaxel and a great variety of scans. 40 bone Mets gone, no new spread into lymph nodes above diaphragm, PSA 0.03.Still 0.03 with Zytiga after 14 months.. God bless chemo.

  • This is what im hoping. That bone mets are gone before it stops working and then move to zytiga for longer term management. Ive heard great things about zytiga, but glad to do chemo first since im still strong.

  • Did you start zytiga right after chemo? Or wait until PSA started to rise?

  • My last chemo (no 10) was May 10th, 2016. I had a 4/5 month break still on Zoladex, all the bone and other scans, then Zytiga. All preplanned, my entire treatment planned 2.5 years ago and still on that schedule. No worries about PSA as a precursor to Zytiga.

  • Thanks! Are you castrate resistant or still "normal"?

  • Having early stage treatment with 6 cycles no bone mets PSA 8.7. Apart from tiredness & fatigue the thing I hate the most is that all food & drink tastes horrible & don't feel like eating or drinking anything.

  • at age 67, my husband was able to tolerate 8 rounds of docetaxel before it stopped working.

  • Surprisingly, there is no standard for the number of Docetaxel cycles.

    Study [1] found a distinct advantage in ≥9.

    Study [2] reported superiority with ≥8, & >10 was even better than 8-10.

    Both [1] & [2] were on CRPC cases, so the actual survival stats are not useful to you.

    A new study [3] address fatigue:

    "Across four docetaxel cycles, fatigue scores were higher in the first week and decreased over weeks two and three. Whilst men randomised to modafinil had reduced fatigue scores, cumulative docetaxel had little impact. Younger men (55-68 years) had significantly reduced fatigue scores, whereas current and ex-smokers had higher scores. There was no significant change in mood status or haemoglobin across treatment cycles. Men described both 'somnolence' and 'muscle fatigue' contributing significantly to their symptom complex."

    Provides no clue as to a possible limit. Seems that more is better if it can be tolerated, & your age is an advantage in that regard.

    Study [4] suggests that circulating cancer cells offer a clue as to survival. "The longest {overall survival} was in patients negative for {circulating tumor cells}" Makes sense. Perhaps the test would be useful before making a decision to halt therapy.

    You might be interested in study [5]: "A Phase II Trial of Docetaxel with Rapid Androgen Cycling as a Treatment for Patients with Prostate Cancer" Involves Denmeade of BAT fame, if you have been following that thread.

    Best -Patrick

    [1] ncbi.nlm.nih.gov/pubmed/276...

    [2] ncbi.nlm.nih.gov/pubmed/275...

    [3] ncbi.nlm.nih.gov/pubmed/284...

    [4] ncbi.nlm.nih.gov/pubmed/270...

    [5] ncbi.nlm.nih.gov/pmc/articl... Full Text.

  • How do they test for circulating tumor cells?

  • Patrick, I am following Denmeade, { Chemo, with BAT}, Interesting--I think he is setting up a new trial as to this--and looking for funds. It is good to have a believer, and that he keeps looking for the twist that works for more than 60 % of CRPC patients. To him working is to be greater than 50% reduction, in PSA or Mets. He also for those that read between us--is his theory of very early onset use of BAT, as soon as ADT, reaches a low nadir.

    Nalakrats

  • After 6 Taxotere sessions, the PSA was still in teens from 840 and MedOnc told me he would continue until I said "stop" or the #s plateaued. I did 9 more and got to 0.7 and then I asked for Metformin and Lipitor and then had a nadir of 0.2. Stage IV, GL7 (4+3), mets to ureter lymph nodes.

    Randy

  • How did you decide to stop? You wanted to or it stkpped working?

  • We got to #15 on 12/17/16 and he then said let's see what the #s are and the it was a 0.7 and I didn't ask for more. I felt fine during the chemos and fasted 2 days before each - Randy

  • What's the purpose of Lipitor? Do you have any studies you can share as to why it might help? Thanks.

    Andrew

  • I am 68. I am on round 7, get round 8, next week. I am on same protocol: Keep taking docetaxel, til I can not handle side effects any more, or until there is radiographic evidence of tumor growth. Yes, I have had numerous mets to pelvis, spine, some to liver. PSA was 42 when I started docetaxel, now 0.43. All tumors appear to have shrunk. Liver numbers are coming down. I have been pretty steady state, biggest issue now is light headed ness, dizziness and fatigue. Not sure if this is due to chemo or cortico-steroids that I am taking to fight side effects, trying to figure that out. I am two weeks into this cycle and still feeling strong effects.

  • But aren't you in a different situation from BigM62? He has just started ADT. What is your treatment history?

  • I started in Sep 2012 with ADT. Had casodex and bicalutimide until Jun 2013. Then did galeterone trial for 31 days, then Enzalutimide trial from Nov 2013 until July 2016. Also started Lupron in Nov 2013 until Nov 2016, Also did denosumab from Jan 2014 until Sep 2016, with ONJ developing. A biopsy in Aug 2016, with Foundation One, Provenge, then Phase 1 trial with AZD-8186, with Liver injury. Then a retrial with AZD-8186 at half dose for 6 days. Then Abiraterone for two months, then 19 fractions for spinal nerve root collapse, then Chemo with docetaxel and carboplatin since May (seven rounds)

  • Sounds like you are castrate resistant. I would probably be doing the same thing you are. Hope the treatments continue to keep the beast at bay.

  • I did early chemotherapy too, so I think that's a good idea. So far your response has been good.

    I'm not a doctor, but I disagree with keeping you on more than 6 cycles of chemo. This approach doesn't make sense to me unless you are castrate resistant and neither zytiga or Xtandi works or if you were never responsive to AR-based treatments. Sounds like you are not in that situation. The benefits of chemotherapy can start to diminish at some point and there is also value in keeping open the potential for re-challenging the same chemotherapy later.

    There has been at least one study done regarding the benefits of continuing chemo beyond 10 cycles. In that study, no additional benefit was gained by going beyond 10 cycles. This study was done with men who are castrate resistant, not with men who have just started ADT.

    ncbi.nlm.nih.gov/pmc/articl...

    Personally, I would get a second opinion.

  • I appreciate your view Greg. I was comfortable with the MO opinion, but you have left me with some questions i dont have answers to. SO THANKS! Why is it important if im castrate resistant for continued chemo? I should not be at this point. As you pointed out, im newly diagnosed and less than 6 mo treatment.

  • Unfortunately, after you exhaust the AR-based treatments, there are not many options left. After primary ADT (Lupron or similar), then secondary ADT (Xtandi or Zytiga) you typically try chemo or something new if you can get on a trial. At that point, you may also have developed mutations that respond to one or more types of chemotherapy. So when that time comes, if chemo is working and you can take it, you can just keep it going. Some people go a long time on chemo, there are some here on this forum.

    It's only recently that chemotherapy is being used up front in the treatment of prostate cancer. But it still has a role later on after castrate resistance occurs.

  • Sorry for all my questions, but even if i go long on chemo, cant i still move to zytiga after? What is the benefit of stopping chemo before tumors are gone and moving to zytiga sooner?

  • It's not that there's a benefit in stopping, the problem is that there is no proven benefit for continuing beyond 6 cycles if you are still hormone sensitive. Chemotherapy is toxic and hard on your body, often the side effects are cumulative so I wouldn't do more than is recommended unless you have no other option. I would also be concerned about a lot of chemotherapy upfront potentially selecting out chemo-resistant cancer cells, but I don't know if there is any evidence to support that. That's my opinion. I'm sure there are others that have done more than 6 cycles up front, but again the benefit is not proven as far as I know.

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