I had an interesting and unexpected conversation with my "second opinion" MO. I went to see him regarding adding Metformin to my list of medications (He's a well known expert - more on Metformin later), but the focus of the conversation turned into adding Olaparib to my existing treatment regime of Zytiga/ADT/Prednisone, because of my BRCA2 mutation.
He basically shared his intuition and gut feeling with me - no phase III certainty. He suggested that adding Olaparib BEFORE cancer cells can form large colonies and become castrate resistant should improve outcomes. He pointed out - correctly - that if past decade of cancer research has shown us anything is to act EARLY and AGGRESSIVELY (as tolerated).
My initial reactions were three folds: First, why not stay the course and wait for more effective PARP formulation (e.g. nano formulation) down the road. Second, What if I develop early resistance against PARP because of the early introduction. Third, the side effects. He admitted they are real risks, but pointed out that they had the same concerns with adding docetaxel and abiraterone in STAMPEDE and LATITUDE trials which were proven wrong. PARP inhibitors are also "generally" well tolerated.
I'd like to hear thoughts from the members here, especially those who have been on PARP inhibitors.
As for Metformin, he said he just released a paper on his latest "Telemedicine-Enabled" study (JCO publication). His conclusion:
"Metformin was generally well tolerated but associated with modest anticancer activity".
In person he was a lot more upbeat about its use and effects and suggested I add it to my intake.