Any experience with PARP inhibitors (Niraparib)?

[ArabianNights]

Hello,

I am new to this forum. It seems like an amazing support community.

My dad is 72, PSA is rising after radiation treatment and hormone therapy for the past 2 years. He has now become castrate resistant and mets on bones in his pelvic area, arm, spine and neck.

He has the following options.

1) Abiraterone with denosumab and prednisone

2) Join a clinical trial which combines the above along with immunotheraphy (pembrolizumab). I've read some papers, and while some have experienced very positive benefits, these seems overall, there is not much benefit.

3) Last option is to see if his cancer is genetic. If so, he will qualify for a trial that combines option 1 with a PARP inhibitor (Niraparib). However, we have to wait a couple of weeks for the results of this test to see if he qualifies. Also, half the patients will receive a placebo.

I just wanted to hear some feedback if anyone has used PARP inhibitors and if its worth the wait.

[Tall_Allen]

Start with a genomic test of a biopsy from one of his larger mets. That will tell him if he are likely to respond to pembro (MSI-hi/dMMR), or a PARP inhibitor (if BRCA1/2 mutant).

You didn't list chemo or Xofigo among the options - why?

[ArabianNights in reply to Tall_Allen]

Doctor said chemo was unnecessary at this time. No pain and no sympathy yet.

I got a second opinion from another doctor who also did not mention chemo as an option.

[Tall_Allen in reply to ArabianNights]

Is he seeing an oncologist at a top cancer center? He may have some comorbiditythat precludes chemo, otherwise it should be considered as should Xofigo.

[HopingForTheBest1]

I am BRCA2+. Have been on Olaparib for past 10 months. PSA has been undetectable for past 9 months.

[ArabianNights]

His PSA has more than doubled in a month. It went from 1 to 2.7 in 6 weeks.

I wonder if it is worth to wait another 3 weeks to get the results and another 3 to be considered for a trial (6 or more weeks). Or should he start the Abiraterone right away? Doctors won’t have him join the clinical trial if he begins with Abiraterone now.

[CalBear74 in reply to ArabianNights]

My principal: always let your medical self-interest preempt issues around procedures related to clinical trials, Especially those that could result in a placebo. Start the Abiraterone.

[vandy69]

After several Guardant360 liquid biopsies over the years, my cancer had an ATM defect which qualified me for the PARP inhibitor Lynparza.

Lynparza worked for about 9 months before cancer found a workaround. Do not recall any serious SEs. Lynparza can be expensive so check your Dad’s coverage if he goes forward.

Best Wishes. Never Give In.

Mark, Atlanta

[j-o-h-n]

Greetings.... Tell your dad this is not the end of the world and to sit back and smile.

Good Luck, Good Health and Good Humor.

j-o-h-n Friday 11/22/2019 7:00 PM EST - JFK assassination 1963