Liver/lung metastasis and carboplatin - Advanced Prostate...

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Liver/lung metastasis and carboplatin

dunde8889 profile image
25 Replies

My dad's oncologist plans to do only taxotere for him (he has not received any chemo yet). I see people have been on carboplatin and taxotere. Is there evidence it helps? And is the combo standard for liver/lung metastasis?

Edited - I meant carboplatin

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dunde8889 profile image
dunde8889
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25 Replies

Often, soft tissue metastases such as lung and liver have cancer cells that have neuroendocrine characteristics. For that type of cancer, Carboplatin is useful. Since the cells are mixed with other adenocarcinoma cells, doctors will often combine it with Docetaxel. Another regimen that's used is Cisplatin + Etoposide.

The only way to know for sure whether there is NEPC is to have a biospy. There are also some blood tests such as NSE and Chromogranin A, but they are not reliable enough to be sure there is NEPC cells. This is something to discuss with his doctor.

dunde8889 profile image
dunde8889 in reply to

Thanks I'll ask the doctor about a biopsy.

in reply todunde8889

If they do a biopsy, I would think the liver would be less risky than the lungs. Please let us know what his doctor says. Wishing him the best.

dunde8889 profile image
dunde8889 in reply to

Thanks for your kind words

dunde8889 profile image
dunde8889 in reply to

I spoke to him and he said he wants to start taxotere rather than delay another couple weeks waiting for the biopsy since the cancer is aggressive. If he doesn’t respond we would then do the biopsy.

Grumpyswife profile image
Grumpyswife in reply to

I think there is a clinical trial for a scan that shows neuroendocrine type prostate cancer. It is being done at Emory in Atlanta and is called Galium Dotatate.

dunde8889 profile image
dunde8889

Thanks. Seems like that is not approved for prostate cancer although some doctors use it. I'm doubting Kaiser would recommend it or cover it. Also my dad has lung metastasis so I wonder if it would benefit him without chemo

tango65 profile image
tango65 in reply todunde8889

May be a possibility if the liver metastases persist after chemo.

Tall_Allen profile image
Tall_Allen

No, it is not standard to add carboplatin. The only reason to do so is if pathology or germline testing reveals a rare type of prostate cancer not susceptible to taxanes. It may also be true that men with DNA repair defects (like BRCA2) that may benefit from PARP inhibitors, may benefit from carboplatin.

Easey profile image
Easey in reply toTall_Allen

I have the somatic BRCA mutation and did very well with rucaparib (PARP) regarding liver mets. Starting cabazitaxel and wondering about adding carboplatin - When?

Tall_Allen profile image
Tall_Allen in reply toEasey

cabazitaxel+carboplatin at the same time.

dougnola profile image
dougnola

I did carboplatin and taxotere after radiation with ADT (currently Eligard and Zytiga/prednisone). Only had bone Mets (lots of those but no liver yet). Also I’m CHEK2. It was more a precautionary “add on” because he wanted to be as aggressive as possible since everything else was in great shape.

I’m glad to have done this and I can’t personally compare this to any other chemo first hand, but I’ve got to say, rounds 3-6 of that double chemo really knocked me on my ass. Man, that was hard.

I wish you only the best!...I’m still here more than 2.5 years later with a ND PSA and doing all I can to stay healthy.

henukit profile image
henukit in reply todougnola

Did you have RP or RT on the prostate?

dougnola profile image
dougnola in reply tohenukit

Hi there. I had neither. Strangely, my prostate tumor was pretty small considering how it had spread (psa of 500). I was actually asymptomatic down there. I had intense pain and numbness in my arm, neck, and back (due to tumors in my neck/back) and fatigue/appetite loss. Radiation(w lots of steroids) was to neck and spine tumors for pain and paralysis mitigation...it was a judgment call but I think the right one.

henukit profile image
henukit in reply todougnola

Thanks for the details. I was curious, cause it's somwhat similar to mine, PSA 500 but I had huge prostate tumor which completely gone after docetaxel and ADT and still not active. But I never achieved ND, my lowest was 0.5. Few months later, in spring I had three bone mets became active. Had to treat them with radiation, all markers went down with pain. Now is getting ready for double chemo Jevtana + carboplatinum). I haven't had second line anti-adrogens yet.

dougnola profile image
dougnola in reply tohenukit

Interesting. It’s worth noting that I had about 9 months of a really low PSA (0.1-0.2) before it dropped to ND one year ago. My bone NM scan in 8/18 that showed no visible tumor in my prostate (like you) or bones coincided with my psa when it finally dropped to ND. So that scan (which was a scary Christmas tree in 1/17) that showed nothing visible might have been the case earlier w low psa. God speed on your second round of chemo! Doug

henukit profile image
henukit in reply todougnola

Amazing response, glad treatment works so well for you! What's Gleason, btw?

dunde8889 profile image
dunde8889 in reply todougnola

Thanks for sharing. Our oncologist wants to start with taxotere first and see how he responds.

vandy69 profile image
vandy69

I have lymph node and liver mets. Chemo was Docetaxel/Carboplatin combo for 2 rounds (12 cycles). It worked both times as PSA declined and liver mets became smaller.

Best Wishes. Never Give In.

Mark, Atlanta

dunde8889 profile image
dunde8889 in reply tovandy69

Did you have any symptoms prior to the diagnosis of liver Mets? My dad has decreased appetite, fatigue, weight loss the last few months.

vandy69 profile image
vandy69 in reply todunde8889

I had no symptoms prior to diagnosis of 20+ liver lesions. Had CT guided biopsy of liver to confirm prostate cancer mets rather than straight up liver cancer. Immediately began chemo.

Mark, Atlanta

dunde8889 profile image
dunde8889 in reply tovandy69

He just checked liver tests and they went up ALT 190, AST 140, bilirubin normal. Now the oncologist is changing from docetaxel to jevtana. Were you liver test high before docetaxel? Just curious if its standard not to use docetaxel with elevated liver tests.

vandy69 profile image
vandy69

I am dealing with mets in multiple lymph nodes and liver, which required the Docetaxel/Carboplatin combo to work on both.

Mark, Atlanta

dunde8889 profile image
dunde8889 in reply tovandy69

Thanks Mark for your input. Wish you all the best.

vandy69 profile image
vandy69 in reply todunde8889

Thanks. Never Give In.

Mark

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