Clinical Trial vs. Zytega

[Schess]

Hi all. My husband’s MPC has become resistant to all standard treatment. Xtandi was discontinued in May, as PSA began to rise again and lymph node cluster was growing. 2nd line chemo was done May-August, but PSA rose between every treatment, lymph node cluster doubled in size, two new bone mets appeared. He has qualified for an immunotherapy clinical trial for which he will sign consent this week. Obviously, his cancer is aggressive. Here is my question- He has not yet tried Zytega. The doctor said it only has a 30-35% chance of helping since he became resistant to Xtandi. My husband feels like the experimental route is the only way to go at this point, and doesn’t want to lose his spot in the trial. I am a wreck about the trial, as dosing can be toxic, side effects unknown, effectiveness unknown, etc. My mind keeps coming back to Zytega. Any thoughts? P.S. our son is getting married July 2019. Our main goal is for him to make it to the wedding.

[Grumpyswife]

From what I have read the doctor is correct. Your husband could do the immunotherapy trial and afterward try Zytiga or Lut177 treatment as needed.

[Schess in reply to Grumpyswife]

Thank you for your reply. Lut177 has never been mentioned to us and this is the first I’ve heard of it. I will Google it to learn more.

[Grumpyswife in reply to Schess]

There are several posts about it here if you read down or search. There are clinical trials happening in the US now and having had chemo already is required.

[tango65 in reply to Schess]

Lu 177 PSMA could be used if the cancer is PSMA positive. He would need a Ga 68 PSMA PET/CT or a 18F DCFpyl PET/CT study. There are clinical trials for these studies and for Lu 177 PSMA treatment.

Search in clinicaltrials.gov for Ga 68 PSMA , 18F DCFpyl and Lu 177 PSMA. There is also the possibility of getting treatment in Europe and in Australia but the treatment cost around 10K euros. There are several posts about Lu177 in this forum. I had explained my experience with Lu 177 treatment done in Germany.

Immunotherapy could be useful. I had the vaccine Prostvac in 2007 and it stopped the cancer for 6 years, this vaccine does not work with castration resistant prostate cancer. Zytiga may not work well having failed other anti-androgens.

[Tall_Allen in reply to tango65]

There is a randomized trial now in Omaha, Indianapolis, and at Mayo (so far). It is 2:1 randomized, but there is no assurance he will get it. Here's the contact info:

clinicaltrials.gov/ct2/show...

There's a Phase 1/2 (non-randomized) trial in Phoenix where everyone gets the medicine. I've heard there is a long wait, but you can try:

clinicaltrials.gov/ct2/show...

Scott Tagawa is doing some phase 1 trials at Weill Cornell in NYC. He is also testing Ac-225-PSMA, which may be more effective:

clinicaltrials.gov/ct2/show...

clinicaltrials.gov/ct2/show...

clinicaltrials.gov/ct2/show...

You can also pay for treatment at UCLA, which is about $9000. However going to Australia, Germany, or India may be less expensive.

[Tall_Allen in reply to Schess]

At the bottom of the following article, there are several links about it:

pcnrv.blogspot.com/2017/09/...

[Schess in reply to Tall_Allen]

Thank you so much. We are very interested in learning more about this.

[pinejogave]

Schess Do you mind sharing what immuno trial your joining?

Dennis

[Schess in reply to pinejogave]

Phase 2 Navaraxin in combination with Pembrolizumab

[pinejogave in reply to Schess]

Schess What Medical Group are you speaking with regarding the trial? Dennis

[Olivia007]

Try Zytiga try try everything!! Ur in my thoughts and prayers!!!

[j-o-h-n]

to Schess: Well as I've posted before Pembrolizumab (Keytruda) has been effective (so far) in treating my lung melanoma.

Good Luck and Good Health.

j-o-h-n Wednesday 09/12/2018 4:31 PM EDT

[Happybiker]

I do not have any experience with clinical trials, but my dad took Xtandi (he had started Lupron a few months prior when psa was 250) for 5 months, then when his body quit responding to it. With the Xtandi and Lupron his psa went down to about 8-12. Then after a few months it went up to 25 or so) Dr. put him on Zytiga which gave him another 2 years. When Zytiga stopped working, the dr. cautiously offered chemo, but my dad, at 84 and with nephrostomy tubes and chronic infections, chose hospice. For what it is worth, he lived 8 months past the time he stopped Zytiga (PSA went up to 46, so dr. stopped it). My dad experience some pelvic pain for about a month - 4 months before he died. I am thankful he did not have chronic pain. Can you trial the Zytiga or would it disqualify him from a trial?