Cabizataxel/carbo not working

[Blair77]

Well Mike started his 5th cycle today and his PSA has risen the last 2 blood draws. His ALP and LDH has also risen. Is there anything left? I’m pursuing LU-177 but it’s not easy to figure out logistics when you still have 2 young kids at home. Feeling deflated 😕

[Tall_Allen]

Didn't you say previously that his cancer doesn't put out much PSA? That would mean PSA can't be used as a biomarker to judge efficacy. What about his bone alkaline phosphatase? radiographic progression? Are there liver mets? Did a biopsy show PSMA expression?

[Blair77 in reply to Tall_Allen]

It doesn’t produce much but it’s gone up from 4 to 6 in the last 2 weeks. If it weren’t for the increased LDH and ALK I might not have put too much thought in the numbers. I asked Dr Aggarwal about running an IHC analysis on the biopsy they took recently but it was a bone met they biopsied and he said the pathologist who do bone marrow biopsies do not routinely run IHC rather they send them for genomic analysis which they performed through STRATA. Again, no targetable mutations.

[Tall_Allen in reply to Blair77]

Well, IHC can tell you if his tumors are PSMA-avid plus a number of other actionable things (e.g. neuroendocrine, somatostatin, AR, PSA), which is not something they check on the genomic analysis. I'm surprised that UCSF doesn't do it routinely. I see the Lu-177-PSMA-617+Keytruda trial at UCSF was suspended due to drug availability - do they expect to re-start it?

[Blair77 in reply to Tall_Allen]

I asked the NP about the availability of LU-177 and she said they had been having a nightmare of a time getting it. Of course Mike won’t qualify due to his secondary cancer.

[Hidden]

Xofigo is already approved and should be an option. It works on bone mets which is usually what causes the ALP to go up.

Has he had any molecular testing to look for treatable mutations? If he hasn't, that might be worth doing.

[Blair77 in reply to Hidden]

PTEN and TMPR nothing targetable

[Fairwind]

If his scans show most of his mets are in his bones, then Radium-223 (Xofigo) works well for many patients. BAT might be worth a try ..If nothing else, it tends to "reset" the cancer so Zytiga works again. Provenge might be worth a try..These things should keep him going until they approve LU-177..Sometimes with the Cabazitaxel they add a platinum chemo agent which seems to work better than Caba alone..But the R-223 might be a better choice depending on how his scans look..

[Schwah]

Is he well enough to travel on his own for LU177 so you can stay with the kids? Can you guys swing it financially? A psma scan will tell you if it might work . It may be his best shot.

Schwah

[Blair77 in reply to Schwah]

I’m working on it... I think we could tap some resources and swing it. But I’d hate to spend the money only to find the treatment didn’t work at all. He’s well enough I think to travel alone but gets easily flustered/ stressed out these days and imagine the travel would really put him on edge. So much!