Chemo vs clinical trial

[joann48]

We are trying to make a decision. Chemo Doxataxel (2nd round) or phase 1 trials. We are receiving direction from the Dr at this point. Hormonal treatment did not work. Any ideas ????

[Hidden]

Which clinical trial?

[joann48 in reply to Hidden]

not sure. They want us to speak to Dr at sloan who does phase 1 trials. He does not have the biomarkers for the immunotherapy trial we were hoping for,

[Hidden]

My choice would be to go with Docetaxel chemo until it's not working, then look for something else such as Cabazitaxel chemo. I would also have some genetic testing done to see if there are any mutations that are "actionable" such as BRCA 1, BRCA 2, ATM, etc. With soft tissue mets and poor response to hormone based treatments, I would want to look for neuroendocrine differentiation and possibly do platinum-based chemo if that was the case.

I'm not a doctor, but that's what I would be discussing with my doctor.

[tango65]

One possibility could be to discuss with the doctors the use of Xofigo a radioactive treatment very effective with bone metastases. You could also discuss Provenge , a vaccine which could prolong life about the same than chemo. You could investigate the clinical trials for Lu 177 PSMA or AC 225 PSMA at clinicaltrials.gov and discuss them with the doctors.. He may qualify for those trials. These treaments are systemic treatment with radioactive material which can kill cancer cells in the bones but also in any other part of the body (one difference with Xofigo). If they could do a biopsy of the metastases, they could study if there are genetic mutations which could respond to specific treatments, such as Keytrude, Opdivo and others.

[joann48 in reply to tango65]

we are very confused. He has had xofigo just recently and the there was a spread of a lesion to an area above his kidney. He had a second biopsy but there were negative biomarkers so he did not qualify for the trial using a drug and immunotherapy. Disappointed with the communication for future treatments. Thank you

[tango65 in reply to joann48]

Perhaps you should explore the trials with PSMA and Lu177 or Ac 225 and discuss them with the doctors .

clinicaltrials.gov/ct2/resu...

clinicaltrials.gov/ct2/resu...

Phase 1 trials will provide the drug which is an advantage over randomized phase II or III trials, but nobody knows for sure if the drug will have an impact on his disease and the intensity of the side effects.

The Lu 177 PSMA has been used in Europe , mainly in Germany and in Australia for years. I had treatment with Lu 177 PSMA in Germany in 2016 without any side effect, It can be very effective in many patients. With Lu 177 PSMA bone marrow supression may happen only in patients with large number of bone metastases. Ac 225 has been used for a couple of years in Germany and it may be more effective than Lu 177 PSMA. Ac 225 could be associated with problems with the salivary glands and bone marrow.

[Tall_Allen]

You have to hear about the clinical trials before you can decide. MSK has many promising ones, and phase 1 means he gets the drug.