ADT + Taxane Based Therapy for Newly Diagnosed mHSPCa

[6357axbz]

Is it true that the subject treatment has only been shown to extend OS for patients with a high number of mets at time of diagnosis and not so much for patients with low metastatic burden?

[GP24]

See this article:

targetedonc.com/publication...

It says: "“When we look at [patients with] high-volume disease in CHAARTED, we see this rather dramatic improvement in overall survival with the addition of docetaxel. But in the low-volume disease [group], we didn’t see that, and that was confirmed when they looked at the longer-term follow-up for these patients,” Higano said. Therefore, it seems that docetaxel does not benefit patients with low-volume disease, whereas patients with high-volume disease do benefit."

[6357axbz in reply to GP24]

Many thanks GP24! That helps.

[Tall_Allen]

Yes, kinda. CHAARTED showed in a subgroup analyses that only newly diagnosed men with multiple mets benefited, but that men who were oligometastatic did not. BUT both CHAARTED and STAMPEDE showed that the benefit accrued to the entire group of metastatic men in those studies. Some very big MOs (like Antonarakis at JH, and James in the UK) argue that one has to interpret subgroup analyses with caution because they are not sufficiently powered to detect the effect. I certainly understand their point, from a statistical POV. My feeling (and it is just my feeling) is that because abiraterone seems to work well regardless of tumor burden, it makes sense to me to start with docetaxel if the tumor burden is high, and to start with Zytiga if the tumor burden is low.

[6357axbz in reply to Tall_Allen]

Thanks TA

[Schwah in reply to Tall_Allen]

Or go with all three as I did, if you want to hit it hard early...although no studies (yet) to prove that helps. Just logic. But there were no studies showing early Zytega with adt was going to be so affective but some doctors were doing it long before those studies proved it.

Schwah

[EdBar in reply to Schwah]

I did the same, hit it hard early, per Snuffy Myers and a talented, knowledgeable radiologist, ADT, chemo, radiation, just passed the 5 year mark, PSA still undetectable. Still on triple ADT. Fingers crossed it continues. Feeling blessed.

Ed

[Tall_Allen in reply to EdBar]

Schwah and Edbar - did you have multiple metastases?

[EdBar in reply to Tall_Allen]

Yes, multiple mets to spine, pelvis, sternum, ribs and several lymph nodes. Gleason 9

[azalea18 in reply to EdBar]

Really encouraging! We (my husband and I) are facing the decision now whether to go with adding Zytiga or Docetaxel and have decided to start with Docetaxel due to multiple mets.

[6357axbz in reply to Tall_Allen]

FYI, I just received an emailed response from my MO to my emailed question about timing for adding other treatments to ADT,

“The studies (Stampede, Chaartered, Latitude) that used combined treatments generally treated patients with larger tumor burdens (>3 bone lesions or visceral, such as liver, metastases) than you have.

The studies also could not show whether patients who responded well to hormone ablative therapy alone (i.e., PSA decreased to a nadir of less than 0.2) would have done just well to early vs concurrent docetaxel or abiraterone.”

I’ll be speaking with him later today.

[Tall_Allen in reply to 6357axbz]

That is not true. CHAARTED had a planned subgroup analysis where they segregated patients into low burden vs high burden who received docetaxel+SOC. (SOC was hormone ablative therapy.) STAMPEDE did an unplanned secondary analysis and found that Zytiga was equally effective and BETTER THAN SOC independent of the number of metastases.

This article has links to the published data:

pcnrv.blogspot.com/2017/06/...

[6357axbz in reply to Tall_Allen]

Thanks TA. I met with Dr Tu today and he’ll prescribe Zytiga if I choose to add that to lupron, and is having his nurse check with my insurance to see what coverage I have. If I recall from looking into this earlier Medicare provided a descending co-pay schedule so by years end it’s considerably lower in cost than retail. Also my RO here at MDA recommends it.

[6357axbz in reply to Tall_Allen]

Dr Tu was also concerned that taking Zytiga/prednisone now would preclude my eligibility for their Dynamo trial:

“The goal of this clinical research study is to find out if the combination of apalutamide (also known as ARN-509 or JNJ-56021927), abiraterone acetate, and prednisone can be given with either ipilimumab or cabazitaxel plus carboplatin to control metastatic CRPC. The safety and effectiveness of these drug combinations and their effect on the immune system will also be studied.”

Of course that is an unknown while Z/P now is proven.

[Tall_Allen in reply to 6357axbz]

I very much like their DYNAMO trial - when will you know if you get in?

[6357axbz in reply to Tall_Allen]

I believe once I go HS.

[6357axbz in reply to 6357axbz]

Error

I mean CR

[6357axbz in reply to Tall_Allen]

I mean CR

clinicaltrials.gov/ct2/show...

[Tall_Allen in reply to 6357axbz]

As much as I like DYNAMO, I don't think that it makes sense to hold off on the best therapy you can get now in order to qualify. By the time you are CRPC, there will be new medicines that you may qualify for.

[6357axbz in reply to Tall_Allen]

Thanks Tall Allen

[6357axbz in reply to 6357axbz]

My RO also agrees with adding Abiraterone and echoed your thoughts about more options being available when CRPC occurs. So, a majority of experts in my sphere agree. I decided to start Abiraterone.

For others in a similar situation as me, FYI, my RO informed me yesterday that the plan is to continue ADT for 6 months after completion of my 30 IMRT sessions, then stop until PSA begins to increase. Kind of an intermittent therapy approach.

[cesanon]

What is mHSPCa?

[GP24 in reply to cesanon]

metastatic Hormone Sensitive Prostate Cancer

[j-o-h-n in reply to GP24]

OTFFUIOTA

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 04/07/2019 3:50 PM DST

[j-o-h-n in reply to GP24]

Sorry: OH THANKS FOR FILLING US IN ON THE ACRONYM...

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 04/07/2019 3:53 PM DST

[Hidden]

cancerres.aacrjournals.org/...

ncbi.nlm.nih.gov/pubmed/236...

And Another: clinicaltrials.gov/ct2/show...

Gourd Dancer

[6357axbz in reply to Hidden]

Thanks gd, much appreciated