Dynamo Trial

[JamesAtlanta]

I mentioned on earlier posts that when my PSA reaches 2.0 my doctor at MD Anderson wants me to either start Zytiga with prednisone or join the Dynamo clinical trial (NCT02703623).

My PSA jumped 0.5 points this month, to 1.8. It has doubled in 9-months. So I want to begin determining which treatment I want to do next.

As a reminder, diagnosed in 2015, PSA 227, bone met in T8 vertebra, Gleason 4+4=8, ADT since diagnosis, 6-rounds of docetaxyl, radiation of T8. My overall health is good, still able to work full time. I do have muscle weakness, but still exercise a lot, manageable fatigue, and a little memory loss at times.

Is anyone on this site in the Dynamo trial? If so, what are your thoughts? My local oncologist read the trial and seemed a bit alarmed with the potential side effects and toxicity of the drugs, depending upon what group I might be assigned. He seemed to lean toward just starting Zytiga and prednisone.

And asking a broader question, what considerations should I have if I elect to enter into any clinical trial?

Thanks for any insight you may have.

[BigM62]

Im not informed enough on Dynamo, but seems like for the folks that Zytiga is working for that it works well for a long time. Im currently on Docetaxel until it stops working - but zytiga is my next choice and am hopeful it will keep me going. Can you still enter Dynamo if Zytiga fails?

[JamesAtlanta in reply to BigM62]

Thanks for your response. I don’t think I can enter the trial later because one of the groups actually uses Zytiga. But I’ll certainly ask.

Have a great day!

[jal1954 in reply to BigM62]

No. You can't enter DYNAMO if you've taken Zytega.

[TommyTV]

I started on the Stampede trial here in the UK 6 years ago, PSA just under 600, Gleason 7, 7 major bone Mets. I started on Zytiga with Prednisone immediately along side Zoladex. As I understand it, this now appears to be the best course of action, closing 2 pathways seems to stop the PCa becoming CR for a much longer period. I think where you are going is the original use for the drug, which was used as you became CR, and it extended life.

The problems with Zytiga are that I’d doesn’t suit everyone, it stresses your liver so a close eye must be kept on Potassium and Calcium levels. I’ve been visiting the clinic every 4 weeks for the last 6 years for full blood tests. My current PSA is <0.1.

Good luck with your future treatments, there’s new drugs coming out all the time now.

Martin

[JamesAtlanta in reply to TommyTV]

Thanks, Martin!

Best of luck with your journey, as well!

[Hidden]

I just googled Dynamo Trial, and it came back with a study for Lymphoma. I'm with you on the Z and PSA creep. My nadir was 1 this time last year after two months on Zytiga. It had dropped from 29. But, since then it has risen by .2 for several months, then .4, then .6. And, now I'm at 3.7. My MedOnc says he doesn't want to change until my PSA doubles. So, I say, what actually constitutes a PSA rise?

Joe

[pjoshea13]

James,

I can understand why Anderson wants to sign you up, but wonder if there is a particular appeal to you at this point?

For those who haven't seen it - here's a link that describes the arms of the trial:

clinicaltrials.gov/ct2/show...

Apalutamide (ARN-509) is an as yet unapproved, improved & gentler alternative to Xtandi. There was a Phase I trial:

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

ncbi.nlm.nih.gov/pubmed/286...

(An older antiandrogen option is Casodex, of course.)

Ipilimumab activates the immune system.

There was a Phase III tial of Ipilimumab (in CRPC after Docetaxel):

ncbi.nlm.nih.gov/pubmed/248...

Cabazitaxel is a taxane - as is Docetaxel - it was approved in June 2010 by the U.S. Food and Drug Administration for treatment of metastatic castrate-resistant prostate cancer (mCRPC) in men previously treated with Docetaxel.

-Patrick

[JamesAtlanta]

Patrick,

Thanks for the reply. The question you asked me is really the crux of what I’m trying to understand - why would joining this trial benefit me?

My goal is to ensure I’m doing everything I can to fight my PCa. Not sure if some of the trial treatments, depending upon which group I’m assigned, will potentially yield a better result for me than simply starting Zytiga plus prednisone.

How would you suggest I look at this, given the background I shared in my post earlier? I read all your posts and I value your opinion.

Have a great day!

James

[Lunbo]

I'm 80, 16 years of PCa and just finished 5yrs on Zitiga with Pred. and now on Xtandis --my MO enabled me to circumvent other chemo but still on Lupron & Xgeva for bone mets. PSA now up to 15---go for Zytiga, few side effects.

[JamesAtlanta in reply to Lunbo]

Thank you for the advice. Much appreciated! And congratulations on your tremendous success fighting PCa - quite encouraging for all of us!