Xtandi while undergoing Docetaxel/Carboplatin chemo

[vandy69]

On Thursday I will have my 3rd round of chemo with Docetaxel/Carboplatin combo. In each of the other 2 rounds, we used Xtandi as a rechallenge after 6 cycles of chemo. PCa is in lymph nodes and liver, under control in lymph nodes but not in liver per recent MRI

My Med Onc says to stay on Xtandi throughout this chemo round.

Anyone out there been down this road?

Thanks.

Best Wishes. Never Give In.

Mark, Atlanta

[tango65]

It could help to prolong progression free survival at 6 months.

It may not improve overall survival:

urotoday.com/conference-hig...

Best of luck.

[vandy69 in reply to tango65]

Thanks for the reference. Now I know that I am not alone in this treatment.

Mark, Atlanta

[tango65 in reply to vandy69]

Keep us informed. Best of luck

[tango65 in reply to vandy69]

Liver metastases could be treated directly with SIr microspheres.

sirtex.com/us/clinicians/ab...

ncbi.nlm.nih.gov/pmc/articl...

[vandy69 in reply to tango65]

My Med Onc calls SIR a “Hail Mary” for PCa in liver. It works much better on regular liver cancer. He has used it before.

Thanks.

Mark, Atlanta

[DSEE]

Yes -

Aside from carboplatin.

I was only on Xtandi and taxotere for a short time.

Never taxotere and carboplatin together and not sure why.

PSA rose sharply from 26 to 44.7 from May to August.

So going for scans after 4 th round chemo-

Then decide what might be added on 9-06 after scans .

Anxious to see if liver Mets look better-

Lots of bone Mets

No lymph node involvement.

Keep me posted on you.

Wondering if the Xtandi will be added back in- or carboplatin.

[vandy69 in reply to DSEE]

Will keep you informed. My PSA took off after last round of chemo in March 2019 to 48, but came back down in 4 months with Xtandi.

Addition of Carboplatin may assist with liver mets.

Never Give In.

Mark, Atlanta

[DSEE in reply to vandy69]

How are you tolerating the combo?

[vandy69 in reply to DSEE]

Have had combo for 12 infusions (2 rounds of 6 cycles each). Thursday will be the beginning of chemo round 3 (infusion 13).

Have tolerated them well. Main SE is fatigue, which gets worse as cycles go on. Always have drip of Aloxi at beginning of each infusion for nausea and end each infusion with On Body Injector of Neulasta for white blood cells.

Mark, Atlanta

[DarkEnergy]

Hi Mark,

I've added chemo to SOC way, but not Xtandi. Currently, taking Lupron (3 months shots) with Zometa, daily Zytiga/Prednisone - and just completed my third Taxotere infusion.

So, it's usually Lupron and Zytiga, or Lupron and Taxotere, or Lupron and Xtandi, but hardly adding Taxotere to Lupron(Zytiga or Xtandi), yikes - sorry for playing twister!

Being treated with Lupron, Zytiga and Taxotere seems to be "controversial" with the brothers here...

Anyway, seems like you're not taking Lupron or the like with Xtandi prior? I'm interested with your case for the "strategic" rationale for adding Taxotere?

[vandy69 in reply to DarkEnergy]

I just had my 12 week injection of Trelstar, which is like Lupron, so either Lupron, Firmagon, or Trelstar continuously for the past 7 years.

As Med Onc described it, I have 2 kinds of metastatic PCa. The one in my lymph nodes which makes PSa and responds to Xtandi and Docetaxel and the one in my liver which does not make PSA and responds to Carboplatin.

The chemo which begins Thursday is exactly the same as my previous 2 rounds of 6 cycles each. Difference this time will be continuance of rechallenge with Xtandi.

Never Give In.

Mark

[DarkEnergy in reply to vandy69]

Awesome brother, obviously you got a kick-ass oncologist, targeted treatment based on your specific evidence is not blanket SOC.

I'm sure you're provocative in meetings with the doc - onwards and never give in!

[vandy69 in reply to DarkEnergy]

You are so right with Med Oncs. First it was Dr. Charles “Snuffy” Myers and now with Dr. Vasily Assikis here in Atlanta with the Piedmont Cancer Institute. Makes a difference!

Mark

[DarkEnergy in reply to vandy69]

My favorite Dr Myers talk: grandroundsinurology.com/du...

The combination treatments makes so much sense, even biology heeds to mathematics.

My Oncologist, Dr Mark Pomerantz, from Dana Farber is kewl, we can discuss anything with open mind, we've added Taxotere to Lupron, Zometa and Zytiga!

[DSEE]

Mark-

I am also in Atlanta.

Today MO added carboplatin in addition to taxotere-

First infusion is Monday.

Mets in liver increased after 4 taxotere infusions.

Hoping this is a good thing-

And will control growth in liver-

No lymph Mets but significant bone Mets which also increased.

From what I read you tolerate this combination well?

Never give in-

[vandy69 in reply to DSEE]

Good Saturday Morning,

I just had beginning of third round of Docetaxel/Carboplatin chemo on Thursday (13th infusion as previous rounds were 6 cycles each). My chemo Is at Piedmont West, Piedmont Cancer Institute).

Yes, I have tolerated this treatment well, with main SE being in neuropathy in feet.

So far, treatment has worked in combo with Xtandi rechallenge between chemos.

Never Give In.

Mark

[DSEE in reply to vandy69]

I just got out of hospital after another blood infection.

Carbo taxotere combo dropped me to neutropenia-

Better now-

How are you tolerating?

[vandy69 in reply to DSEE]

Are you getting On Body Injector of Neulasta? I have it attached to my upper arm at the end of each infusion. It boosts the white blood cells and I have never had an infection. I have tolerated each of 13 infusions so far with main side effect being severe fatigue for 4-5 days after treatments.

Mark

[DSEE in reply to vandy69]

Oh yes-

I get Neulasta as an Injection-

The on body devise worked awhile but then the changed to injection.

This was first carbo therapy along with taxotere-

But PSA week after first dose went from 44 to 77-

Waiting to see what they do next.

[DSEE]

One question-

How far apart were your round?

[vandy69 in reply to DSEE]

Average about 5 1/2 months between chemo rounds. Reused Xtandi in those months between chemo.

Mark

[Grumpyswife]

Hi Mark, I am curious about who suggested your chemo combination. Was it Dr. Assikis or the MD Anderson doctors? We visited Dr. Assikis a few times and he seemed very SOC. He was discouraging about Lutetium which was dismaying. However, we may see him again if he is more progressive with chemo combination as that's where my husband seems headed next. We live near Atlanta. Thanks.

Mary

[vandy69 in reply to Grumpyswife]

Dr. Assikis has been my primary Med Onc since Dr. Charles “Snuffy” Myers retired. Dr. Assikis has managed all 3 of my chemo rounds with Docetaxel and Carboplatin. Carboplatin was required because of PCa mets in my liver.

Mark

[DSEE]

Haven’t seen a post from you in awhile.

My carbo taxotere was discontinued- now on Jevtana and side effects are more tolerable.

How about you?

[vandy69 in reply to DSEE]

Good Thursday Morning DSEE,

Sorry that you had stop the combo, but since I have not yet had Jevtana, may I please ask that you keep me updated on your progress with it.

As for me, just had 3rd Docetaxel/Carboplatin chemo in this round on Tuesday (#15 from start of all chemo rounds).

Continue to take Xtandi throughout this round of 6 cycles. Miracle impact on PSA, as 6 months ago it was 48 and now is .2!

Will have liver MRI in 2 weeks to see what is going on in there. Major SE from so much chemo plus Xtandi is fatigue which is lasting longer, but I am still here.

Best Wishes. Never Give In.

Mark, Atlanta

[DSEE in reply to vandy69]

Good to know you are doing well.

Will look forward to hearing your MRI shows liver Mets in remission!

My PSA actually more than doubled to 196 on carbo - doxetel combo.

Also hospitalized with neutropenia and blood infection.

Post Jevtana(cabazitaxel) chemo only 10 days and seemingly tolerating well.

Second injection a week from this Monday.

Hoping bringing PSA back down occurs.

Just great fatigue so far.

I am fortunate.

[DSEE]

Have not seen a post in awhile -

How are you doing?

This is the wife of The person posting here.

He is now in Hospice care but pain under control and spirits good.