Enzamet

[mediocra]

Hi, wanted to get the group's opinion/input. My dad has metastatic prostate cancer, 1 year into diagnosis/treatment. Initial PSA > 2200 with several bone mets. Underwent ADT + Lupron + 6 rounds of docetaxel. PSA nadir 0.01. Currently hovering around 0.01-0.02.

Our oncologist and I had previously discussed potentially adding abiraterone shortly after chemotherapy (never did start it though). Now with the Enzamet results, was wondering if I should still push for that, or just wait until/unless PSA starts rising? Thanks, and happy Thanksgiving.

[Tall_Allen]

Xtandi has not yet been approved for mHSPC (I'm sure it will be soon), but Zytiga and Erleada have been approved.

[mediocra in reply to Tall_Allen]

What do you think about adding it after docetaxel (but before there has been any PSA increase)? My oncologist and I had been considering it, but the Enzamet data seems to suggest no benefit (albeit with enzalutamide) in patients who received up front chemo.

[Tall_Allen in reply to mediocra]

In the ARCHES trial, Xtandi delayed progression significantly in patients pretreated with docetaxel.

[LearnAll]

Why would you like to add or change the treatment which is working so beautifully ?

[mediocra in reply to LearnAll]

Just wanted to be appropriately/reasonably aggressive. Intuitively seems to make sense to attack the cancer from different angles while it is knocked down.

[LearnAll in reply to mediocra]

Enzamet study reported that 3 year survival rate was 72% without adding Enzalutamide whereas it was 80% after adding Enzalutamide.

It comes with additional side effects and therefore you have to make a decision taking into account pros and cons of addition.

[mediocra in reply to LearnAll]

My understanding was there was no statistical benefit seen in subset of patients who had already received chemotherapy.

[LearnAll in reply to mediocra]

I think that kind of difference can be accomplished by plant based diet, turmeric, quercetin, ginger ,garlic and green tea . Without much side effects. Exercise can add to further improvement.

BTW.. Enzalutamide has a lot of financial toxicity. .it costs $12000 per month. Drug companies and their agents will push it very hard until people figure out that about

1 % patients taking it have Seizures...sometimes while driving a car on highway !

[JimVanHorn]

I had 72 radiations over eleven years and 6 1/2 years of Lupron. I had PCa and metastatic bone cancer. My PSA was 0.006 for 4 1/2 years. I was taken off all therapy in April. 2018 and my PSA has gone up to 0.06. The reason I am telling you this is so you know that I also am watching for an increase in my PSA form these "state of senescence" cells. I have to watch my Testosterone level so it does not come back too fast. I was told Testosterone can also stimulate the reproduction of cells, but that these cells are not as healthy as normal Prostate cells. I will see my cancer doctor in three weeks and find out. I wish your father well and will be hoping for the best!

[mediocra]

He's currently still on Lupron + bicalutamide.