Only early chemo? Or early abiraterone too?

[Jlcwonderboy]

Hello,

My father was diagnosed last July, stage 4, mets to spine, PSA 27 at dx, no Gleason score given.

He has undergone 6 cycles of Docetaxel chemotherapy plus ADT as per the standard of care here in the UK. PSA down to 0.2.

My question is, do people think it is worth pushing for the possibility of also adding abiraterone early (i.e. pre castrate resistance). This isn’t yet available on our NHS but we could make arrangements. My concern is that he will become castrate resistant before he has the chance to start on abiraterone, lessening it’s effectiveness.

I’ve seen study results suggesting that early chemo and early abiraterone are comparable in their benefit, but not a lot to say if there is any benefit or problem with having BOTH treatments at an ‘early’ stage.

Does anyone have any feelings/info on this?

Thanks as always

J

[Canoehead]

There is no study showing the effect of early chemo followed by abiraterone, but many US doctors are doing just that on the belief that the abiraterone will still delay the onset of castrate resistance., since the 2 treatments are completely different. I finished docetaxel 4 week’s ago and am starting zytiga now. Good luck to your dad.

[Jlcwonderboy in reply to Canoehead]

Thanks for your reply - that was my feeing too. Now just need to find the £££ to get hold of it!!

[Tall_Allen]

There have only been sequencing studies of Zytiga after docetaxel among men with mCRPC, and they are all retrospective. FWIW...

This study suggests that docetaxel -> cabazitaxel -> Zytiga or Xtandi is optimal:

meetinglibrary.asco.org/rec...

This one found that a good response to docetaxel predicted a good response to Zytiga:

link.springer.com/article/1...

As for combining them, this study showed that PSA declines were excellent and toxicity was acceptable from the combination:

europeanurology.com/article...

While it was not among men who were still hormone-sensitive, it suggests that the combo may be effective and tolerable.

[Litlerny]

I just finished 6 cycles of docetaxel on 3/13/18, and have had one follow up visit with my Mayo Jax MO’s PA. She did not seem real supportive of immediately starting Zytiga following the completion of the docetaxel. I meet with my MO again on Monday. Assuming my labs are all good, I will revisit the issue with my MO. I wish there was more data available supporting the use of Zytiga immediately following chemo in oligometastatic castrate sensitive patients. If anyone knows of any, please let me know.

Mark