Enzalutamide NFG* for me. Clinical trials beckon.

[Hazard]

* NFG = No good.

I finished up 9 cycles of docetaxal in July in a chemo-resistant state and started on Enzalutamide. Unfortunately Enza has done absolutely nothing. No impact on disease progression at all. I remain on Zolodex of course and MO added metformin and statins to my cocktail of drugs to no avail. Probably not a surprise since I became castrate resistant 3 months after starting Zolodex (2017).

So what's next? I am looking at 2 clinical trials at Peter Mac in Melbourne.

1. Galahad trial. This is looking at somatic DNA repair issues (I had germ line DNA tests in Jan 2018 and it was all clear). Blood was drawn yesterday, I get results in 2.5 weeks. MO suspects that we will find something given my recent history (primary ADT resistance, early metastisis to liver and other soft tissues but no bone mets). If there are DNA issues (eg BRCA genes) then I will start appropriate therapy (eg PARP inhibitors)

2. TheraP trial. Participants are randomised to receive either cabazitaxal or Lutetium 177. I will only join this trial if somatic DNA tests come back negative.

in the meantime, MO has asked me to stop Enzalutamide as it must be flushed from the system for 4 weeks before PARP inhibitors can be taken. This is sort of OK because Enza was doing nothing anyway, but I do feel a bit helpless with a rising PSA and no current therapy except for a useless Zolodex implant.

Anyone else in Australia on these trials? If so how are you going?

Ever onwards and keep fighting!

[johngwilk]

Germline testing should have detected any BRCA mutations, so it's possibly some other mutation(s) that will be detected by advanced genomic testing. My germline test was clear, but the more advanced test derived from a tumor biopsy found a CDK12 DNA repair mutation that opens me to platinum-based chemo, a PARP inhibitor (olaparib/Lynparza) that I just started, or Keytruda.

Best of luck on your latest test results.

[Hazard in reply to johngwilk]

Thanks John. I will update when I get DNA results. In the meantime I hope that PARP inhibitors help you.

Regards, Hazard

[snoraste]

I think taking another look at the somatic mutation is a good idea, as is Lu177. Have you looked into BAT? Johns Hopkins is running a trial. Perhaps you can also see if you are mocrosatellite stable or not to evaluate any immunotherapy options. Along the same lines, I hear there are some PDL-1/PD1 mono and combo therapies in clinical trials as well. Hang in there. You are nowhere near the finish line.

[Hazard in reply to snoraste]

Thanks Snoraste. BAT sounds interesting but John Hopkins is a bit far for me. There is a trial starting in Sydney, if it goes well I imagine that it will be extended to Melbourne.

But you are right there are plenty of clinical trials. MO has already told me that she is in process of starting a PD-1 trial in Melbourne, if next treatment is not successful then she has suggested that this is next best option for me. As you say, plenty of options.

Regards, Hazard

[Blackpatch]

Just caught up with your situation - I’m in Melbourne too, and just wanted to wish you the very best of luck. It looks like you’ve had a rough trot and are well and truly due a break - I hope the genetic testing opens up a new avenue (I thought the germ line testing would have been adequate for that purpose) or that the Lu/Cab trial opens up a new avenue.

All the very best, I look fwd to hearing some good news from you soon....

Stuart

[Hazard in reply to Blackpatch]

Thanks Stuart. I am due to get results on 22 Oct and we will make a decision then. In the meantime, I remain asymptomatic - I feel fine physically - but as you might imagine i am getting a bit nervous waiting for a treatment plan while PCa continues to grow.

Good luck with your treatment, and keep fighting.

Regards, Hazard