One or the other?

practiceupdate.com/content/...

In 2015, the use of six cycles of docetaxel plus ADT was demonstrated to be superior in terms of survival in those who received ADT alone for the hormone-sensitive metastatic prostate cancer subset.3

Data presented by Dr. Matthew Sydes at ESMO 2017 indicate that docetaxel and abiraterone/prednisone are equivalent in terms of providing survival benefit. The costs and side effects are quite different.

Of course what do I know?

[vandy69]

Good Morning nameless9999,

I have had the Zytiga/prednisone combo with ADT way back in January 2013 when it was first FDA approved for use prior to chemo. Dr. Charles "Snuffy" Myers was always on cutting edge and I was early in treatment for Stage 4 mets in many lymph nodes PCa (see bio for history). Not cheap, but I had great coverage. Side effects minimal, mainly facial swelling from prednisone. Worked for about 1 1/2 years.

Now, beginning September 2017, I am having chemo, with Docetaxel and Carboplatin. Side effects much more severe, but it is cheap compared to Zytiga at full retail. Chemo with ADT at original diagnosis was not standard or an option in January 2013.

Since Dr. Myers has retired, I am managed by Dr. Oliver Sartor at Tulane. If I were diagnosed today with what I had in Fall of 2012, he would go with ADT plus Zytiga/prednisone combo, to minimize side effects, if insurance coverage and cost could match chemo option.

Best wishes. Never Give In.

Mark, Atlanta

[mlengle in reply to vandy69]

Mark - hopefully your side affects are not ruining the holidays totally. I'm looking at the Taxotere/Carboplatin combo in a month. Had Taxotere 18 months ago when first diagnosed. Just wondering, since Tax and Doc are similar what side affects you had. My onc did say it can be tough.

Best,

Mike

[vandy69 in reply to mlengle]

Hi Mike,

Thanks for asking about SE over Christmas. I had chemo #5 on 12/19, and I have noticed that as I have more infusions, the recovery period is longer. Today is 1 week after #5 and I still am not back to my new normal.

My Med Onc uses an infusion of Aloxi before Docetaxel. It prevents nausea and I have had none! He also recommends daily oral 100mg B6 as preventive for neuropathy, but I also ice my hands and feet during Docetaxel, so no neuropathy so far.

Carboplatin infusion is only 30 minutes or so, Docetaxel is 1 hour.

At end of infusions, I am given On Body Injector of Neulasta, which injects me 27 hours after placement on my right arm. To prevent bone pain from Neulasta, my Med Onc suggests daily Claritin for 6 days, beginning day before chemo. He has also prescribed Dexamethasone (steroid) twice daily the day before, the day of, and the day after chemo.

My side effects have been fatigue, flu-like feeling, and constipation beginning on Day 3 after chemo. My chemos are on Tuesdays, so by Thursday I am starting to feel bad, and stay in pjs day on Friday. Fatigue lingers on.

My abdomen has become swollen and Med Onc says this chemo combo can cause fluid retention in that area--had to buy new pants with larger waist! Hopefully I will go back to normal after end of my 6 cycles.

I use Biotene products for mouth care, as I have had some mouth/throat irritation.

Appetite is unchanged, so no weight loss.

Hope this helps. Ask more specifics if needed. All in all, it has not been as bad as I was prepared for.

PSA has dropped from 10.8 to .3 and liver mets per MRI have been positively impacted, so at least, it is working for me.

Best wishes. Never Give In.

Mark, Atlanta

[mlengle in reply to vandy69]

Thanks Mark,

Were the first infusions better, less fatigue? My first thee rounds of Taxotare were not bad, fatigue up front but bounced back. The last three, especially #6 hit me much harder, lots of fatigue and overall weakness. Could hardly walk a block. Diet had to be controlled closely or get sever stomach cramps/pains. Constipation or loose stools.

At #6 eye ducts closed causing tearing, toe nails fell off (others distorted), neuropathy hands & feet (9 months to totally recover). Head/facial hair returned but 80% of body hair never did. I'm told the "ape look" is out so guess this is a plus :).

Thanks for the info on Docetaxel, Neulasta and the ice treatments. If they don't offer I'll ask. If the neuropathy can be minimized that would be great. Wasn't offered when I took Taxotere.

Also what do you mean by "On Body Injector"?

Too bad this overlapped the holidays but now you can look forward to a better 2018, and is is having a very good affect. Congrats!

Best,

Mike

[vandy69 in reply to mlengle]

Hi Mike,

Yes, I do get more and longer fatigue as I have more chemo cycles. You have me spooked over my next, and last, chemo #6 on 1/9. Hopefully the SE will not be as severe as yours.

Docetaxel is Taxotere, but Aloxi is the anti nausea drug given before any other infusions.

Neulasta boosts your white blood cell count and an On Body Injector (OBI) has been developed so that you do not have to go back to doc's office for an injection. It is attached to your body as a unit the size of a half deck of playing cards and 27 hours after it is attached, it injects you over a 40 minute period. After that, you remove it and dispose of the entire thing. Quite amazing!

Lots of new technology and drugs to minimize some of the SE and risks.

Best wishes. Never Give In.

Mark, Atlanta

[mlengle in reply to vandy69]

Mark,

Please don’t be spooked. One thing I’ve learned is everyone reacts so much differently. My SEs other than fatigue will almost certainly not be the same as yours.

I had to return for the white blood cell booster, the OBI sounds great. I’ll inquire. The knowledge is helpful. If you don’t mind drop me a line at the end of January with an update.

Best,

Mike

[e-mail]

[vandy69 in reply to mlengle]

Will do. If I may ask, why are you getting Carboplatin? Mine is for mets in liver.

Happy New Year!

Mark

[mlengle in reply to vandy69]

I have a BACA 1 gene mutation which is related to my cancer which is very aggressive. Carboplatin has shown to be effective. The mutation is from my mother who died of ovarian cancer. Sister has it and is a breast cancer survivor. The platins are used in both.

Kick ass on the 9th. Look forward hearing from you.

[vandy69 in reply to mlengle]

If that is a BRCA1 mutation, then the oral drug Lynparzacould be used. I took it for 1 year after Guardant360 liquid biopsy found ATM defect. Check it out, it is a PARP inhibitor.