Jevtana (Cabazitaxel)

[Toad1]

After 3 rounds on Jevtana, my PSA continues to rise sharply. During 9 rounds of Taxotere my PSA was about one third as high. I quit Taxotore because of the side effects.

Any suggestions???

[Tall_Allen]

You can try re-challenging with Zytiga.

[cesanon in reply to Tall_Allen]

Tall Allen,

Myers once told me that in about 25% of cases, Zytiga would increase PSA.

Have you read or heard of anything like that?

[Tall_Allen in reply to cesanon]

Almost everything that kills cancer cells will increase PSA in the short run, but after the dead cells are cleared, PSA should go down. If it doesn't go down over time, it's probably not working.

[Toad1 in reply to cesanon]

Zytiga worked twice for me to immediately drop PSA. Sadly, what works for one does not work for all.

[Toad1 in reply to Tall_Allen]

Done and even the second time it worked for quite a while.

Hate to do it, but thinking about going back to Taxitore.

Any thoughts?

[Tall_Allen in reply to Toad1]

If Taxotere never stopped working for you, I see no reason to not try going back to it. Have you done Provenge yet? Also, consider a radiopharmaceutical or a PARP inhibitor in clinical trials. Not a bad idea to biopsy a recent lymph node for an immunohistological and genomic analysis (e.g., Foundation One).

[Toad1 in reply to Tall_Allen]

Tks for responding. Going back to taxotore is on my bucket list — see new MO tomorrow. Yes Provenge.

2 blood based genetic analyses and sadly nothing treatable including PARP inhibitors.

Unfortunately, pelvic lymph nodes appear to be very deep making both biopsies and radiation chancy.

[Tall_Allen in reply to Toad1]

When you say "blood based" are you talking about CTC or germline? A somatic test is very different from a germline test. Can you clarify what you mean by "very deep"? a friend just had a para-aortic node sampled - they went in through the back. Radiation can treat all pelvic nodes through the common iliacs and the para-ortics.

[Toad1 in reply to Tall_Allen]

The genetic tests were Guardant 360 (twice) and an expanded BRACA1/2 Germline run by my centers geneticist. Nothing treatable.

My MO didn’t want to radiate for fear of causing me more harm than good.

[Tall_Allen in reply to Toad1]

You should talk to a radiation oncologist. Pelvic LNs are all reachable unless you have an anatomic abnormality.

[Toad1 in reply to Tall_Allen]

Saw new MO yesterday. Will stay on Jevtana and Zytiga for one more cycle and get a PETPC PET AXUMIN scan in early January. If, as I suspect, the problem is my pelvic lymph nodes, I may have to radiate.

Tks.

[johngwilk]

Earlier this year I participated in an enzalutamide + cabazitaxel trial. My PSA continued to rise throughout 8 cycles, so I dropped out of the trial.

[Toad1 in reply to johngwilk]

Enzalutamide worked for me to lower PSA but gave me neurological side effects.

Still looking for a silver bullet!

[cesanon in reply to Toad1]

What "neurological side effects"

[Toad1 in reply to cesanon]

It was a while ago so I don’t remember most but I had to stop immediately for a week and then gradually work back up to the full dose . The one I do remember was walking and talking with a friend and abruptly starting talking gibberish. Scared me.

Might have been a TIA.

[Survivor1965]

We added Carboplatin to the Jevtana and that worked really good. PSA went down and the tumors degraded. All while on hormones of course, I think Firmagon or Lupron.

[Toad1 in reply to Survivor1965]

Tks!!! Good timing. See new MO tomorrow. Will ask.