What's next after Xtandi fails? - Advanced Prostate...

Advanced Prostate Cancer
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What's next after Xtandi fails?

Seeking other's ideas as I sense his 16 month run with Xtandi will be ending soon. His is PSA is fluttering.

He hasn't had chemo yet but has lost so much weight that he seems too frail for chemo. Popping a pill is easier but the side effects of Xtandi have been brutal for him.

At age 75 and almost 19 years of treatments under his belt we are also considering no more treatments.

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Talk to your Doc, about Durolidamide, it is beyond Xtandi in its ability to work like Xtandi. It is about to be approved---may still be in trial--papers for final approval submitted to FDA.

You may be able to obtain under the Right To Try Laws, of your State, or the Executive Order signed by Trump. Ask your Doctor--most have never been involved in these new laws, which give patients right to try drugs not yet approved.

The weight loss is concerning---anyone say what it is from--is he eating a 2,000 caloric diet?

Also is your Doctor, aware of the addition of Indomethacin to Xtandi--25 Mgs twice a day with meals as being a booster to Xtandi? Another trial in the offering. But this is simple as this drug is an old Pain reliever for Gout. Any Doctor can prescribe it. Ask--or do a Google search and print, Indomethacin and Xtandi, or Indom. and Prostate Cancer.

Nalakrats

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Darolutamide was tested in castrate resistant men without mets, or in the M0 stage. Trial is done, very positive results, being fast tracked by the FDA, but still a time before it will be approved.

Joel

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Any trials done with mets?

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Word is that there is a lot of pressure for this late fall. It was originally set for 2022, then 2020, it is on a fast train--unless you have contacts closer to the subject.

Nalakrats

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Darolutamide is meant for non-metastatic, castrate resistant, prostate cancer patients. I doubt very much mjbach's husband is non-metastatic.

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He has been metastatic outside the prostate area for about four years.

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Yes, I sensed that he would be "metastatic". Hence, no darolutamide for him, even if and when it becomes SOC. Unless, of course, they decide that it can indeed be given even to "metastatic" patients.

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I don't have the link handy, but I recall that a metastatic study is underway with results expected in 2022. Long way away if you need it now. Right to try may be best option? Still new at this myself.

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Thanks, Tom. No, I do not need darolutamide. I am currently doing Lu-177 and will know whether its a success or failure by roughly mid--August, 2019. By then, I should have worked out with my quacks, Plan B and even Plan C, if required.

Cheers, Tom, enjoy life :-)

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I agree with Nalakrats on Xtandi--there is a clinical trial now involving indomethacin to break Xtandi resistance--some other info:

auajournals.org/article/S00...

The concern about his weight/debility--Is there any chance he is depressed? The addition of remeron 15 mg may help pick up his appetite and is helpful for sleep. Several other meds frequently used with the elderly as an appetite stimulant are cyproheptadine 4 mg , megesterol acetate oral suspension, and marinol...

You may get more calories also by giving Boost between meals and if he is not getting enough protein then consider adding Muscle Tech Protein Powder--it adds a lot of protein and calories--if mixed with the boost would likely give about 500 cals per shake and 30 grams of protein.. Hope this provides some ideas to help him...

Best of luck to you and him....

Fish

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He had thyroid tests done last December as a prerequisite for a brain scan. The neurologist who ordered them must not have looked at the results and/or did not bring them to our attention.

Recently, the gastroenterologist saw those results and said that's why he is losing weight. That set in motion a battery of thyroid tests showing he has Graves disease which is hyperthyroidism. Now he is started on meds for that.

He probably is depressed but denies it and won't do depression meds due to the side effects. We are hesitant to add any more meds due to side effects.

He will soon have a Gallium scan which will inform our decision as well.

We will ask the MO about Indomethacin and it's side effects.

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It sounds like you are getting a good handle on the weight thing with the meds for Grave's disease. With improved performance, I hope he will be able to tolerate docetaxel (which has demonstrated success when there have been visceral mets). It can also sometimes reverse resistance to Zytiga or Xtandi.

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Our fingers and our hearts are crossed for your husband. Keep on keeping on...

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 05/14/2019 5:55 PM DST

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Praying that one of the options above will turn things around.

Hugs,

John

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