Olaparib srudy

[Johnkelsey]

My advanced PCa has metastasized to my vertebrae , today it was declared castrate resistant, after radiation last summer and 16 months of ADT via Lupron.

Today they also offered me a place in a phase 3 double blind study of abiraterone with and without the PARP inhibitor Olaparib. I’m thinking it over.

My hesitation is that earlier studies reported a “clinically significant” gain in some patients, but they don’t say what that really means. And the possible side effects are pretty awful. A couple months maybe isn’t worth the risk of blood/kidney/stomach grief.

Plus while in the study I would not be able to pursue other alternate treatments, I’d have to leave the study first.

Does anyone have pertinent comments/advice for me?

[Fairwind]

What's your PSA now ? R-223 and Provenge are other options and you can always do the Zytiga . Take a close look at the risk benefit ratio with the trial..Is it your BEST option ?

[Johnkelsey in reply to Fairwind]

PSA 3.6... a month ago it was 1.6. Rapid rise.

[Tall_Allen]

PARP inhibitors work best in people with BRCA mutations. Do you have any indication you have that?

pcnrv.blogspot.com/2019/10/...

[Johnkelsey in reply to Tall_Allen]

I think - they threw a lot at me yesterday - that qualifying for the study includes testing my tumor biopsy cores for BRCA. I have had genetic testing in the whole body and don’t have the gene. I’m thinking to decline the study if the tumor core doesn’t have BRCA muatation.

[tango65]

Did they study the somatic genome? The response to olaparib is pretty good in cancers with the BRCA, PALB2, & ATM mutations. (about 75% response in BRCA).

urotoday.com/conference-hig...

If the genome of your cancer is unknown, and the trial is not going to study it, IMHO I will try to get the genome of the cancer studied by direct biopsy or by liquid biopsy (better results with PSA of 10 or more and bone metastases) and see if there are clinical trials for the mutations which could respond to specific drugs. If there are not mutations susceptible to specific treatment I will discuss treatment with chemo, enzalutamide,abiraterone, provenge, xofigo and Lu 177 PSMA.

[Johnkelsey in reply to tango65]

See prev reply. I think qualifying includes finding these markers as mutations in my 18-months old tumor cures (which they kept).

[Magnus1964]

In this study you will definitely be getting the zytiga. So you have nothing to lose.

[Cmdrdata]

Yes I agree with you. I’ve been on Z for 18 months and SEs are no difference from Lupron+Casodex combo. So participating in this study is not a total loss, and if they pay for the Z or Z+O, hey, JohnKelsey should go for it. My 2-cents worth.