Drug Resistence

[taylor123]

Hey guys,

My Father is currently on his third round of hormone blockade.

However it appears he has become Zytiga and or Degarelix resistant.

PSA Feb 25th was 22 and PSA March 25th is 24.

He used Casodex on his first hormone blockade run in March 2014.

He is Chemotherapy and Radiation naive.

Our current oncologist Dr Tucker said they don't use the term Hormone Refractory anymore, and instead say if they have become resistant to a certain drug being used instead.

What options do we have running forward?

Chemotherapy

Lutetium

Keytruda

We will hopefully get in to see Professor De Bono soon, but would be great to have some thoughts from you guys?

Thanks in advance.

[Magnus1964]

How old is your father, general health, etc?

[taylor123 in reply to Magnus1964]

Hey Magnus.

He is 78 but still works running his own business everyday. No pain.

[Magnus1964 in reply to taylor123]

At his age radiation might be a good option. Xtandi is still an option.

[Tall_Allen]

Sometimes switching from prednisone to dexamethasone can extend time on Zytiga. He can try Xtandi for however long it lasts. How many mets does he have and where are they?

Let us know what DeBono says - certainly one of the stars.

[taylor123 in reply to Tall_Allen]

Oh interesting.

Do you know why switching the steroids would make a difference? and can it extend it even after it appears to have failed?

Only mets ever seen were in surrounding lymph nodes. He hasn't had a scan in a while, but will again soon.

[pjoshea13 in reply to taylor123]

See: ncbi.nlm.nih.gov/pubmed/301...

-Patrick

[taylor123 in reply to pjoshea13]

Thanks Patrick

[Tall_Allen in reply to taylor123]

It only made a difference after Zytiga with prednisone failed. I suggest you send the following link to your oncologist and discuss at your next meeting:

onlinelibrary.wiley.com/doi...

[taylor123 in reply to Tall_Allen]

Many thanks!

Really helpful.

[BrentW]

I am on Zytiga. After two months with very nice falls, my PSA went up marginally (about like the rise stated here). My doc said we should try for another month. At the end of that month, my PSA had fallen again -- and has largely continued to do so since, although I have had one more such bounce. We put this down to cancer cells dying and releasing their PSA into my bloodstream en masse. So, perhaps don't panic too much just yet, but persist and see if the same is happening with you.

[taylor123 in reply to BrentW]

Hi Brent, that is very interesting.

We have just acquired the Dexamethasone.

Question is do we stick with Prednisone for another month or swap the steroid now.

Anybody have any thoughts?

[snoraste]

I would add BAT to your list of options to discuss with your MO. It is indicated that BAT can re-sensitize you to Zytiga re-challenge.

[taylor123 in reply to snoraste]

Completely agree, and it has been in the back pocket for a long while. The issue issue finding somebody in the UK who would do it.

I've known Ed Friedman for a long time, and it is something we have discussed a lot way back.

[rassusukumaran in reply to taylor123]

I am in a similar situation as your dad. I live in Malaysia where BTA is a no no. If you find a doctor in the UK willing to do BTA please let me know. Am also consulting Tucker in Spore. Have given him my communications with Denmeade who pioneered BTA in us. However he has not indicated if he would do it on me.

[taylor123 in reply to snoraste]

Do you have a link to the paper that shows this?

[snoraste]

ascopost.com/issues/june-25...

frontiersin.org/articles/10...

There's a Germline/Somatic mutation component to the success, it appears. Have you done any genetic profiling?

ascopubs.org/doi/abs/10.120...

[j-o-h-n]

De Bono = GOOD.

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 03/28/2019 5:08 PM EDT

[taylor123]

Sorry I missed.

Can you elaborate on the genetic profiling?