After 16 months on Zytiga (which started shortly after a failed RP in Jan 2018), my father's PSA jumped from 4 in June to 19 in August to 55 last week. A genetic test showed he has a T878A alteration in his AR gene, which I believe means he is mcrpc and resistant to abiraterone. His doctor is starting him on taxotere on Sept 29th. I'm wondering if anyone is aware of any cross resistance that may impact the efficacy of chemo? I know chemo has been life saving for many people here, especially those who received it early, but I'm not sure about its efficacy in those who have progressed while on Zytiga and I'm seeing some mixed information online. We are very concerned about the side effects of chemo and want to make sure we are making the right decision to go with chemo at what seems to be a late stage of the disease.
They also found a C675 alteration in BRCA1 so are checking to see if this will qualify him for clinical trial for PARP inhibitors (if anyone has information on this alteration that would be most welcome as well) . In any event the MO says he has to go through chemo first before any clinical trial as he's never had it.
Thank you all very much. I'm an only child living on the other side of the world from my father, so it has been quite a lonely experience and this forum has provided invaluable advice and moral support.
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Dani2861
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Another thought would be the ARV-110 clinical trial...An AR degrader that looks promising...
Finally, consider VERU-111 if docetaxel does not work....In clinical trials, it is an alpha and beta tubulin inhibitor --I believe it is an oral formulation and supposedly tolerated well...
Other posters will be along with more ideas I am sure...
In about a year or so, we should see the following vaccine trial which I posted on previously...
Thank you, I had not heard of VERU-111 so will definitely ask our MO about it. I’m also hoping xofigo, ac225 and LU 177 are options down the line but need to discuss with the MO as he hasn’t mentioned.
There is not a definitive agreement about the right sequence of drugs to treat metastatic prostate cancer. There is some "evidence" that the sequence of one anti androgen and then chemo when the anti androgen fails could be more effective than using another anti androgen..
thanks, the Davis trial sounds really interesting. We were also told the chemo might resensitize the cancer to Abiraterone but not sure how often that actually is.
The side effects of chemo are worse the longer you wait. It is possible that chemo may reverse this mutation as it has been found to sometimes for AR-V7. There seems to be a therapeutic overlap between carboplatin and PARP1 inhibitor. MD Anderson is running a trial of cabazitaxel+carboplatin followed by a PARP inhibitor.
Thanks so much, I think his doctor is checking if he can qualify for the Triton trial. Still a bit unclear if the specific BRCA1 alteration qualifies him for the trial or whether it’s a VUS.
I did 8 cycles of Docetaxel/Carboplatin after Zytiga failed (8 months). The efficacy of the chemo was great and side effects tolerable. There was no reason to believe the Zytiga had impacted the chemo at all
After Zytiga failed for me (18 months) I went on taxotere. Side effects were tolerable. Unfortunately that failed as well. Now on Jevtana . 3 cycles in my PSA is decreasing. Chemo side effects are pretty individual. I pray your dad’s are not too bad.
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