Adding Zytiga to Lupron and Casodex

[jdm3]

Recurrent after RP and XRT. One bone met detected with PSMA scan. I had SBRT to the met and have been on Lupron and Casodex for nine months. The numbers are good. T=6 and PSA <0.02. The MO is suggesting adding Zytiga for another six months then stopping to watch the numbers. He feels that intensifying the treatment at this time may be beneficial. There are no evidence-based studies on this, but it seems like a reasonable extrapolation.

I am tolerating the current ADT pretty well and wonder what will happen. Has anyone else added Zytiga to Lupron and Casodex? What kind of additional side effects (if any) did you experience? I'm thinking (hoping!) that since my T is already suppressed, adding the Zytiga may not make much difference in terms of how I feel. Any thoughts?

Thanks,

Josh

[JamesAtlanta]

Hi. I added Zytiga in December. The side effects for me were minimal. Perhaps a little more fatigue ... which I handle by exercising. And my PSA went back to undetectable in a month. I hope you get the same excellent results.

Best,

James

[jdm3 in reply to JamesAtlanta]

Thanks James. I'm hoping the side effects don't get much worse when I add the Zytiga.

[Schwah]

Wrong on the comment that “there are no evidence backed studies “ regarding adding Zytega early. The opposite is true. Latest results from large studies have shown adding early Zytega to lupron reducers deaths by 40%. It’s absolutely the correct thing to do.

Schwah

[jdm3 in reply to Schwah]

Thanks. Yes, I agree with the evidence-based studies adding Zytiga early. However, my understanding is that the cohort was men with multiple mets, many already castrate resistant, and many getting ADT for the first time. There are few, if any data about oligometastatic disease. Hence the MO was reluctant to layer on Zytiga - especially since the Lupron and Casodex are keeping the PSA down. The extrapolation is let's add it anyway and block another androgen pathway and hope that may lead to longer durable remission (dare I say cure?). We believe Zytiga "might" make a difference, but I am wondering about how much worse the side effects might get.

I do have some fatigue, loss of some muscle mass, and an uncooperative penis as a result of the current ADT. But all things considered, feel like I'm doing pretty well. I eat well and exercise a lot.

Thanks,

Josh

[Schwah in reply to jdm3]

pcnrv.blogspot.com/2017/06/... That’s an interesting article on the early use of Zytega for hormone naive newly diagnosed men with metastatic cancer. My MO (dr Mark Scholz out in California) also believes that throwing the kitchen sink at it early could lead to a durable cure or even “cure” in ovliometatastic men. Lupron chemo and Zytega. If A+B is better than A or B alone and B + C is better than B or C below than shouldn’t A+B + C be even better? No proof of all 3 yet but all things are pointing to early use is usually better. I also had my three nets zapped after chemo. Painless and no side affects usually depending upon the locations. Also some theorize that the zapping has an affect on your immune system to go after other smaller microscopic Mets. And for good measure I’m going to do zometa and Celebrex . Those same studies (also discussed in this article ) showed a 22% drop in mortality for that combo with the same men. They arent sure why but they think it somehow protects your bones. The days of lining up your treatments until each fails is becoming more akin to HIV treatments where it took a cocktail of drugs to crest a possible permanent remission. There are side affect if Zytega to some but I lift weights vigorously three days a week and I’ve actually gained muscle mass and lost weight. I have the pictures to prove it. I’d do the Zytega for sure.

Schwah

[jdm3 in reply to Schwah]

Definitely going for the Zytiga. BTW, I had a phone consult in May with Dr. Turner who works with Dr. Scholz. He was very good.

My MO does not agree with A+B+C... yet. He's willing to add the Zytiga, but says the chemo does not appear to make any difference with a few mets and low volume disease. Apparently, chemo is much more effective with multiple mets and higher volume tumor load.

The Zometa + Celebrex data are interesting. I am going to ask about that too. I'm all for the combination of therapies instead of the sequential treatments.

Thanks,

Josh

[vandy69]

Good Monday Morning Josh,

I have been in this battle for six years (please see bio for complete treatment history).

I was treated by Dr. Charles "Snuffy" Myers until his retirement.

As soon as Zytiga was approved pre chemo in January 2013, he immediately added to the triple blockade of Lupron, Casodex, and Avodart. He was a firm believer in hitting aggressive prostate cancer with many agents at the same time.

I do not recall any additional side effects, except face swelling after extended use of prednisone. Went back to normal after off the steroid.

Zytiga worked for me for about 18 months then on to High Dose Ketoconazole.

Best wishes. Never Give In.

Mark, Atlanta

[jdm3]

Thanks Mark. Yes, perhaps the prednisone will have a few effects too. Didn't think of that. Oh joy :-).

Josh