Xtandi alongside chemo for neuroendocrine cancer?

[sem275]

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?

[tango65]

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).

clinicaltrials.gov/ct2/resu...

jnm.snmjournals.org/content...

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.

ncbi.nlm.nih.gov/pubmed/258...

[sem275 in reply to tango65]

Thanks tango65, that is interesting to know and I will read the links. we are in the UK and I have enquired about an Lu177 trial. Just worried he is getting too weak now. All the best

[sem275]

Thanks Nalakrats, I will have a look. All the best

[Tall_Allen]

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:

pcnrv.blogspot.com/2016/12/...

[sem275 in reply to Tall_Allen]

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

[Tall_Allen in reply to sem275]

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.

[sem275 in reply to Tall_Allen]

Ah thanks for explaining, I didn't realise the difference. I will look it further. Best wishes

[mcp1941 in reply to Tall_Allen]

I too needed that clear explanation on LU177. I get results of biopsy on Tuesday. Hoping there is no NE cancer.

[sem275 in reply to mcp1941]

Fingers crossed for you

[Bebby1 in reply to Tall_Allen]

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

Very irregular

Has never had problems

Looked at side effects and this is one albeit not common

He’s miserable

Very flat

Have you heard this?????

[Tall_Allen in reply to Bebby1]

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.

[Bebby1 in reply to Tall_Allen]

Thank you

[j-o-h-n]

Hello Sem,

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

[sem275]

Hi John, yes sorry, it is an oncologist. Best wishes