Zytiga after chemo : Hello guys... - Advanced Prostate...

Advanced Prostate Cancer

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Zytiga after chemo

bhr17
bhr17

Hello guys although I am not a frequent poster I visit this forum all but daily, but today I have a request, I just finished may chemo treatments 10 total, my MO is pretty good at helping, but letting me decide on treatments. PSA went from 1790 to 21 after second treatment and has stabilized at 1.6 for the duration of treatments although I would like this. What is lower after 1790, 1.6 seems ok not undetectable but ok. MO mentioned Starting zytiga as an option with the Lupron but also stated there is not a lot of evidence that it will help with OS,now has anyone have any links or info on this any information would be greatly appreciated

Thank you all for sharing it keeps me hopeful but grounded

Rock on brothers

29 Replies
oldestnewest

Two clinical trials (STAMPEDE and LATITUDE) showed an increase in overall survival for those who took Zytiga along with ADT.

bhr17
bhr17 in reply to gregg57

Yes I have seen both of those studies but unless I am reading them wrong the are comparing ADT and Zytiga to ADT and chemo not what I am looking for my quest is ADT plus Zytiga after ADT and chemo, and any pro or con info, but if I am miss reading these studies please feel free to correct me. I have very thick skin there will never be offense taken from anyone trying to help.

gregg57
gregg57 in reply to bhr17

The first trial (COU-AA-301) was done on patients who became castrate resistant, who had previously had chemotherapy. You could wait until you become castrate resistant before starting Zytiga as I did or do as many others have and start now.

I also had the same sequence of treatments as you. I started Zytiga after I had become castrate resistant and so far it's working for me. My PSA went from around 26 to 0.1 in 5 weeks.

bhr17
bhr17 in reply to gregg57

Thanks for your reply as this is what I am looking for starting now mCSPC or leave it for mCRPC all replies are greatly accomplished

Rock on

Nicnatno
Nicnatno in reply to gregg57

That's awesome Gregg

No , lupron and chemo and of course all the other drugs that go will that line of treatment prednisone etc.

gregg57
gregg57 in reply to bhr17

The original trials that were done to get Zytiga approved were called COU-AA-301 and COU-AA-302

Here's the prescribing label for Zytiga that shows data from that trial showing an increase in overall surivival.

janssenlabels.com/package-i...

I don't understand how your doctor can say there is no evidence Zytiga increases overall survival. There are now 3 major trials that clearly show that.

bhr17
bhr17 in reply to gregg57

My interpretation of his statement is there are few if any trials on starting Zytiga with ongoing ADT after ADT and chemo for mCSPC and I mean right after finished chemo 10 yesterday as to waiting to become mCRPC?

Here are two links for some information on the LATITUDE and STAMPEDE trials. You can also do a search and find out more.

nejm.org/doi/full/10.1056/n...

nejm.org/doi/full/10.1056/N...

bhr17
bhr17 in reply to gregg57

Thanks I found what you where leading me, again thanks but again the decision now or wait? Maybe I should just get stoned and screw this crap! But dam that’s not me I’m a fixer/ facilitator for a living and can’t let it just be what it is got to fix it.

gregg57
gregg57 in reply to bhr17

I had three different doctors tell me to wait until CRPC before Zytiga. Although using Zytiga early before CRPC had just been approved, their argument was that early Chemotherapy OR Zytiga was approved, but not both. They felt like adding additional toxicity was not a good idea.

However, there are many that have used Zytiga after chemo before CRPC, many with good results as far as I know. It was not offered to me so I didn't have the option.

I have discussed this with oncologists at 3 academic centers. The answer to your specific question appears to be unknown. I believe that trials are ongoing but it is too soon to know whether Zytiga after Lupron and chemo, is better before or after castration resistance, or whether timing is irrelevant.

bhr17
bhr17 in reply to john205

Thanks this is what I am finding that yes it is to early and real answers will be a few years out

My MO cautioned that the specific sequencing of Docetaxel followed by Zytiga has not been addressed in a published study, but he agreed with me that using it before castration resistance makes sense in terms of extending remission. So I am doing just that, and for good measure we also did a lengthy course of pelvic radiation. Kill the cancer while it is weak.

Don’t forget about Provenge. It’s an immunotherapy treatment that is proven to help. I had to talk my MO into starting me on Zytiga. I was castrate resistant and PSA at 20 but my MO still wanted to wait. He said once you start you never stop taking it. I got the impression that he felt it was thrvlast resort with no light at the end of the tunnel. Although the tunnel could be a year long or twenty years long. No telling.

My husband did ADT + docetaxel for 6 rounds. Ended Jan 2018. PSA went from over 677 (he didn't get a PSA until after 2 weeks of bicalutimide so we dont know really how high when started) to 20. He is not castration resistant.

Started ADT + Zytiga + Prednisone Feb 2018 and has been on since. His MO says they've found it's best to hit it hard while feeling ok and in good shape. (He is 50 years old and still feels good)PSA went down to lowest of 10.7 in May now at 12 in Oct- (his MO considers that steady from 10.7).

We will see what PSA is in Dec.

My MO also had me do lupron chemo and Zytega. I’ve handled all three very well for about 15 months now. .02 PSA. All these recent studies have shown early intervention is better than waiting . As I’ve said here before if A + B is better than A or B alone and B+ C is better than B it C alone than logic dictates that A+B+C is even better. I went to UCLA to get a second opinion. They said it sounds logical and they’d “love to see a study with all 3” , they can’t recommend it without a clinical trial. In the end I did all 3. But we each have to make our own choices.

Schwah

IDKanything
IDKanything in reply to Schwah

I'm curious, did you do all three at the same time? I have done all three simultaneously and am now starting Radium 223 (Xofigo) today, before the pca has a chance to get stronger again. It's experimental for sure but makes sense to me. It's been a battle with insurance though but so far we've gotten it done.

I've been on Zytiga,Prednisone,Eligard as my first line of treatments along with Xgeva for bone Mets. My PSA has been 0.1 undetectable since the first month. I'm now into my ninth month still undetectable just had my CT and bone scan done last week and results were very good PC is under control and bone Mets are too as is all my blood work normal across the board. ADT does have its draw backs E.D. hot flashes but a small price to pay for staying alive. Side effects are very tolerable after the first few weeks and E.D. can be managed. Never give up never surrender. Leo

Fitzbruce1
Fitzbruce1 in reply to leo2634

Leo- can u tell me what change was there in your bone scan? Do the Mets look smaller, the same,...? I am 3 months into this beast w lots of bone Mets. I have not had a second bone scan yet n just wonder what I can hope for. Glad u are doing well!

leo2634
leo2634 in reply to Fitzbruce1

Well Fitz, I'm now not ashamed to say it again but I was a mess and crying when the doctor came is and sat down all I could think about was why is he sitting down so I don't know what exactly he said but the results were the CT scan showed improvement and bone scan showed that they have subsided. The doctor ended by saying he couldn't be happier with my results so I took my Xgeva shot and out the door I went to call my wife and cry to her. I thank God everyday for another day and for my compassionate Doctor and his staff. My results were as close to normal as can be expected. I feel good and hope to stay that way for along time.

Fitzbruce1
Fitzbruce1 in reply to leo2634

Very cool! I hope to have a similar response in December when I have my 5 month follow up.

How long have you been on Xgeva? I am only on Lupron, Zytiga n Predizone. Nothing for bone health other than hitting the gym, bike riding and paddle boarding.

Happy trails!

leo2634
leo2634 in reply to Fitzbruce1

Xgeva 7 months now I also ride my bike and walk my dog around my development. Keep up the good fight Brother. Leo

I was dx 12/19/17. Stage 4, Gleason 9 (4+5), numerous bone Mets. Started bicaludamude while waiting for my MO appt. in January. Started zytiga, lupron and prednisone. PSA at dx was 34, last reading in July was0.32. All trials have shown OS is improved with this combo. If you were CRPC prior to chemo your PCa may have been re-sensitized. I have seen no studies that suggest waiting would improve OS. Once I'm CR and have gone through chemo my guess is my MO will advise this.

I'm in the same boat: just finished chemo with great response and trying to decide if 1) add Zytiga now or 2) wait and do it later. I will seek 2nd opinion on that definitely but there's no RCT data so most likely everyone will say: we don't know. So it's going to be mostly subjective.

Thanks all I also am finding that there is little data on sequencing of these treatments. I am going in for my first CT and bone scan since the first set in February 2018 I’ll probably go with the Zytiga protocol as I’m not good at waiting and am also a hit it hard when I’m young and strong kind of guy

An Austrian study of this sequencing pre and post chemo in castrate resistance pCa was just posted here.

bhr17
bhr17 in reply to mjbach

This site rocks with 4500+ brothers and sisters searching the internet someone comes up with some research from somewhere in the world.

bhr17
bhr17 in reply to bhr17

Typo 5500+

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