On April 10th with the consent of my MO, I began taking my 1000mg dose of Zytiga/Pred. with food. On average the meals ranged between 500 and 750 calories and 30 to 50 grams of fat. This was a last ditch effort to prolong the effectiveness of Zytiga as my PSA after falling from 32 to 12 began to rise back up, you can read my entire treatment history in my post titled, Viewer Discretion Advised.
Unfortunately combining Zytiga with food did nothing to stop the rise of my PSA, and after 35 days my PSA has risen to 33. Putting that disappointment aside I did not experience any physical side effects. Below I have listed my blood numbers, if anyone has any questions please do ask. BTW I do have Gilbert's syndrome so I'm not sure if that skews my numbers in regards to taking Zytiga with food. Best to all.
March 21 2019. (Prior to taking Zytiga/Food)
ALKALINE PHOSPHATASE 152
ALT 17
AST 15
BILIRUBIN, TOTAL 1.5
GLUCOSE 93
PSA 16.7
April 10 2019. (Prior to taking Zytiga/Food)
ALKALINE PHOSPHATASE 142
ALT 22
AST 23
BILIRUBIN, TOTAL 1.4
GLUCOSE 104
PSA 18.1
April 24 2019. (2 weeks into taking Zytiga/Food)
ALKALINE PHOSPHATASE 154
ALT 18
AST 19
BILIRUBIN, TOTAL 1.4
GLUCOSE 165
PSA 19.6
May 15 2019 (35 days taking Zytiga/Food)
ALKALINE PHOSPHATASE 145
ALT 13
AST 17
BILIRUBIN, TOTAL 1.1
GLUCOSE 112
PSA 33.4
As a note my MO is working on getting me into a trial of Olaparib, Cabazitaxel, Carboplatin, and Prednisone before moving on to a Lu 177-PSMA-617 trial.
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SsamO
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Not sure why you didn't try adding indomethacin to break resistance or, in addition, try changing prednisone out for dexamethasone. These have both shown some benefit to people on Zytiga who start having PSA go up...worth a shot, before moving on...:
Last week I mentioned switching to Dex. but my MO is not a believer, however he was going to run it by his colleague at MD Anderson. As far as indomethacin I was not aware of this and will bring it to my MO's attention this week.. As you say, it is worth a shot. Thanks much.
Psa went from 0.85 tp 2.60 on zytiga and pred. in 6 months changed to dex. and psa dropped .20 in a month I leaned it from this group of wonderful cancer fighters. Talked to 2 MO and they never heard of it. Good luck
"...Talked to 2 MO and they never heard of it...."
Perhaps my MO's reluctance was nothing more than ignorance.... the second time I brought up switching to Dex. I had a copy of a study stating that 56% of those who had made the switch saw either a decrease or stabilization in PSA.. That appeared to garner his attention but as I mentioned he needed further consult, I'll see what he has to say this upcoming week.
That's what I thought as well but the link (haven't read it entirely) Fish has provided does mention abiraterone. As far as Lu-177 I have had chemo, but my MO is suggesting a Olaparib, Cabazitaxel trial first, his reasoning is that Lu-177 can always follow. Can Cabazitaxel follow a Lu-177 trial?
My understanding is that the standard admonishment to take Zytiga on an empty stomach is that the absorption can be increased by food, and the results can be highly variable. From the prescribing information, section 12.3
"In healthy subjects abiraterone Cmax and AUC0–∞ were approximately 7- and 5-fold higher, respectively, when a single dose of abiraterone acetate was administered with a low-fat meal (7% fat, 300 calories) and approximately 17- and 10-fold higher, respectively, when a single dose of abiraterone acetate was administered with a high-fat (57% fat, 825 calories) meal compared to overnight fasting. "
I have no idea how Gilbert's syndrome would affect those results.
Yes, my husband's primary MO (Dr. Bob @ Compassionate Oncology) said that it is roughly $50K in Germany but open to anyone with the supporting scan results.
Gilbert's syndrome (GS) is a mild liver disorder in which the liver does not properly process bilirubin. Many people never have symptoms. Occasionally a slight yellowish color of the skin or whites of the eyes may occur. Other possible symptoms include feeling tired, weakness, and abdominal pain.
But apparently it is around $4K in India (Mumbai) at a hospital where the team is US educated. We are keeping that in mind if he is a candidate and doesn't get into the trial at Weill Cornell. (And if Fenbendazole does work - he's now on day 5.
He decided to do what someone on Joe Tippen's blog did and go 14 days straight before doing the 3 days on / 4 days off. He checked and got the green light from 2 DRs - one is his alternative DR where he gets his IV vitamin C and the other a former MO in Toronto. Neither saw the harm - i.e. won't interfere with anything on his current protocol and both were aware of the past studies. So fingers crossed.
It was a study for indomethacin and abiraterone...there will never be a clinical trial on this because Zytiga is generic....as you are aware, some people who end up resistant on zytiga do not do any better when switched to Xtandi...
Fish
Keep kicking it SsamO ....... get into a trial ... no side effects is great ..I pray that you will be able to find the key to slow the PC in its tracks ..
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- he's now on day 5.
ALKALINE PHOSPHATASE NUMBER HIGHER
Wondering which arm of STAMPEDE dictated my 18 to 16 month ADT plus Zytiga treatment plan ? 
Lymphocytes & Absolute Lymphocytes
Alkaline Phosphatase Rising
Routine alkaline phosphatase and bone specific alkaline phosphatase
