Hi, my dad's cancer has spread to his liver and possibly abdomen and he will be starting chemo in the next week. Xtandi is still working to keep his psa low but not stopping the cancer that has spread through his liver. I wondered from people who have been here if he should continue taking his xtandi for the original cancer while getting chemo for the neuroendocrine cancer? Or does it not work like that? Consultant didn't seem to know and is going to look it up, but they have stopped giving him xtandi at the hospital in the meantime, so perhaps it is no longer considered effective?
Xtandi alongside chemo for neuroendoc... - Advanced Prostate...
Xtandi, is not considered a treatment modality unto itself for Neuroendrocrine Pca.
You may find some posts of mine addressing Neuroendrocrine Pca. There is an experimental drug working well for Neuroendrocrine Blood Cancers, in trial. Assume drug can be obtained under Right to Try Laws--even if your Doctor, is not steady for things like this.
Enter Neuroendrocrine Pca in our search bar--and there are some posts on this subject that may be helpful.
Neuro endocrine prostate cancer is usually treated with a taxane combine with cisplatin or similar and/or etoposide. Since there are somastastin receptors, it could be diagnosed with Ga 68 DOTATATE PET (there is a clinical trial at Emory University).
It could also be treated with Lu 17 DOTATATE (Lutathera) which has been approved by the FDA.
Enzalutamide (Xtandi) could promote the diferentiation of the cancer into neuro endocrine cancer.
He obviously has a combination of two kinds of cancer at the same time. So docetaxel and Xtandi will attack the adenocarcinoma, while carboplatin may be used to attack to NE cancer. Ask the consultant if Lutathera is covered. If his NE cancer expresses somatostatin and/or PD-L1, he might benefit from Lutathera and Keytruda, respectively. Read this:
Thanks tall_allen. He is being treated in hospital at the moment and they have stopped giving him his xtandi, initially until his liver and kidney function improved. Now that it has they haven't started giving him it again. We are wondering if he should start taking it again as the consultant doesn't seem sure. Is there a risk that it can promote the ne cancer as mentioned in tango65's link above. I appreciate you are not doctors but any insight will be helpful. We have asked about Lu177 trials in the past but the consultant seems reluctant to pursue trials. I have contacted the trial coordinator directly, I'm not sure if it is available here outwith a trial. Will ask about eligibility for keytruda also, there is an immunotherapy trial running in glasgow. Thanks Allan and all the best
I think you may be confused about Lu-177. Lu-177 is just a radioactive element. What it is attached to determines its effect. When it is attached to PSMA-617, it attacks adenocarcinoma (which expresses PSMA). When it is attached to DOTATATE (called Lutathera), it attacks neuroendocrine cancer that expresses somatostatin. You have to ascertain that the neuroendocrine cancer does indeed express somatostatin. Lutathera is approved in the US for neuroendocrine cancers of the digestive tract. Whether you can get it for prostate cancer may be problematic.
Ah thanks for explaining, I didn't realise the difference. I will look it further. Best wishes
Hi Tall Allen
You seem to know heaps.... and you make me smile with your comments
It’s a long weekend here in 0z
So no Drs
Husband is currently on enzalutamide 120 mg day ( had to cut down due to side effects)
Zoladex three monthly
Prolia injection monthly for bones
Not long after enzalutamide commenced blood pressure rose
Commenced an antihypertensive
Been on it now two weeks
Last night keep waking with pulse in his neck
Has never had problems
Looked at side effects and this is one albeit not common
Have you heard this?????
It's more common with Zytiga when someone doesn't take enough prednisone with it. A couple of people have mentioned it with enzalutamide. I guess you just treat it symptomatically with BP meds. Or maybe he can switch to Zytiga with prednisone.
Sorry to hear about your Dad's current situation. You keep referring to a "consultant", is that person a Medical Oncologist? If not get one asap.
Good Luck, Good Health and Good Humor.
j-o-h-n Sunday 06/09/2019 10:01 PM DST
Hi John, yes sorry, it is an oncologist. Best wishes