Docetaxel 6 cycles, should it be extended to 10 cycles?

[Cheerr]

Currently, dad is in his 5th cycle.

With each cycle ALP and PSA continue to fall, the lowest being the current one. (PSA = 0.07, ALP = 143 )

|| MHSPC with widespread Bone Mets. Original PSA 143 to 1.43, ALP 887 to 443 with Firmagon, then started chemo ||

- PSA trend during chemo:

0.311 -> 0.252 -> 0.195 -> 0.074

- ALP trend during chemo:

339 -> 305 -> 268 -> 143

I read that some people receive 10 cycles instead of 6.

We have just 1 cycle left and I was wondering if we need more. Can an increase in the total cycles add benefit?

Is this something the MO must consider since the results so far are good? MO never discussed this, the plan is to start Zytiga immediately after 6 cycles.

[LearnAll]

His PSA has come down to an excellent level. His Alk Phos seems still not that good. We need Alk Phos at least below 70-80 because of his bone metastasis.

Whatever way Alk Phos can be brought to 70-80 level should be fine...chemo or No chem

If he is tolerating chemo well then 10 cycles can be considered as eradicating Cancer cell population to lowest possible level ensures better outcome. Its up to your MO if he would like to go for 10 cycles.

[Cheerr in reply to LearnAll]

Yes, he had a high ALP to start with. I agree with you. I wish the ALP further comes down to 70's.

We are yet to see post cycle 5 and cycle 6 results. So 2 more chances, could come down hopefully.

[LearnAll in reply to Cheerr]

O..so two cycle results are still pending ? I did not know that. In that case, we are likely to see ALP close to 80 soon. So, there may not be any need for extra cycles. The rest of cancer cells (if any left) will be killed by Abiraterone.

I did not have chemo or radiation ever.. I just had Lupron and Zytiga and PSA has fallen down from 830 to 0.6 in 7 months. ALP down from 191 to 59.

But, I am on extreme anti cancer diet which includes Turmeric, Garlic, Ginger, Green tea, Grape seed extract, pomegranade seed powder, Quercetin, Cayyene pepper powder, black peeper powder, Guava leaf boiled water, Soursop leaf boiled water, Neem leaf (7 leaves daily by chewing) Spices :rosemary, Oragano, Saffron, parsley etc. EVERY DAY.

Plus some other natural stuff. I have read hundreds of research papers before I designed my super anti cancer concoction.....and of course my 4 mile a day walk.

[Cheerr in reply to LearnAll]

Yes, he's in cycle 5 currently. So yet to see results of 5 & 6.

I like the idea of a natural anti-cancer diet, we do follow it as much as possible too.

We have recently been considering adding Guava leaf tea. Do you have a Guava / Sourspup plant around that you? Since it seems like you are using fresh Guava leaves boiled in water.

[LearnAll in reply to Cheerr]

Yes I have all three trees in my backyard..Guava, Sousop and Neem. First thing in the morning and pluck 7 Neem leaves and chew them. Then,I boil Soursop leaves and Guava leaves and drink this water empty stomach. Then after 20 minutes, prepare my Green and Black tea (mixed) and drink and enjoy reading our forum members postings.

[Oldeenglishbulldogge in reply to LearnAll]

Hi, sorry for just jumping in, but could please send me your diet and a good place to look up some of the stuff you eat. Ii will tell u my situation soon if u don't mind

[LearnAll in reply to Oldeenglishbulldogge]

My basic principle is to eat natural stuff as much as possible...such as fresh ginger, fresh turmeric etc. But sometimes it is not possible to prepare natural and I am OK with using powders packed in capsule form. I make sure that they are simply powders grinded leaves and seeds and do not contain any additives. I have found most of these type of things on Amazon.

First, three types of pepper..Red Cayenne pepper powder (capsaicin), Black pepper powder (Peppirine) and Green chilli pepper powder. Then comes my spices..Turmeric powder, Dried Ginger powder, Dried Garlic powder, Rosemary powder, Oragano powder, Thyme grinded, parsley powder, grape seed extract powder, Pomegranade seed powder , Amla powder and some other herbs. To my pleasant surprise, I was able to buy most of these on Amazon.

I take home made fat free yogurt in a big bowl, add two tablespoons of sodium free Tomato sauce in it. Then Add my concoction of above mentioned spices and herbs in the yogurt. Then I eat this special Yogurt in my breakfast. I grew up in India so I am

familiar with the taste of all these items.

It may sound weird to many people BUT I truly enjoy this breakfast and feel good as

I think this is cancer killer breakfast.

[Oldeenglishbulldogge in reply to LearnAll]

Thank you

[Hidden]

He has had a great response so far. His ALK Phos is likely to continue going down without more chemotherapy. It's almost in range already.

There is no evidence to support a benefit if you go more than 6 cycles when doing early chemotherapy. The problem is some of the side effects of chemotherapy are cumulative, especially neuropathy. There's a good chance he will able to rechallenge chemotherapy at a later date and benefit from that so I wouldn't push more cyles now. Personally, I would not go beyond what's proven. Of course, you should discuss this with his doctor.

How does your dad feel about adding more cycles?

[Cheerr in reply to Hidden]

Thanks Gregg. We are yet to see the ALP levels post 5th and 6th cycles, so possibly it'll come down further.

I'll ask the MO, but I am guessing he would like to stop at 6.

Dad wouldnt want to get more cycles, since cycle 5 has been kind of tough in terms of fatigue. And i'm sure more cycles would only mean way more fatigue.

[Hidden in reply to Cheerr]

Good chance he could benefit from chemo later so wouldn't want to get him totally exhausted with it now. I also went through 6 cycles so can speak from my own experience. By the end I was completely tired of it and so glad I was done, but still willing to do it again later.

The main thing driving the ALK PHOS down is the ADT, not the chemo so it's likely it will continue going down.

One piece of advice about PSA, don't bother looking at the tenths or hundredths. All that does is give you what we call Prostate Specific Anxiety. Nothing under 2 is significant for metastatic prostate cancer patients.

He's had a geat response so far, calls for celebration.

[LearnAll in reply to Hidden]

Nothing under 2.0 is significant in case of metastatic prostate cancer.. "(HSPCa)

I love that sentence...

[tallguy2 in reply to LearnAll]

Well, Not exactly. While it is true that I, for example, am required to wait until my PSA reaches 2.0 before starting a Phase II clinical trial, I have a choice and perhaps Cheerr does too. (I am up to 1.5, up from 1.1 just a month ago.) My choice would be to start Zytiga earlier at, say, a PSA of 1.8. My second specialist has given me that choice. That choice would eliminate my participation in a trial involving Zytiga and a study drug.

In addition, progression of PSA can mean that scans are warranted, even with a PSA of below 2.0.

Bottom line: decision making can still involve me, the patient. I like this.

[Cheerr in reply to Hidden]

Thanks Gregg.

If you dont mind can you tell me what the chemo is doing? When PSA and ALP are going down, can I hope that atleast some/max cancer cells are dying?

Or are they just sleeping due to the ADT and can wake up when ADT stops working?.

[Hidden in reply to Cheerr]

There's no question about killing the cancer when the PSA and ALP are going down, especially so dramatically. They aren't sleeping, they are dead. The problem of course is they're not all dead.

The chemotherapy is also killing the cancer cells, just not as effectively as depriving them of the male hormones they need to reproduce. The advantage of the chemotherapy is that it's also killing cancer cells that are not sensitive to hormones so you are killing a wider spectrum of cancer cells.

The benefits of early chemotherapy are not as immediate as the ADT. They are now discovering in the STAMPEDE trial that the early chemotherapy patients that have survived past the median survival continue to see a benefit.

Later on, when the cancer looses some of its sensitivity to hormones, chemotherapy will become a valuable treatment to have available. The combination of chemotherapy and ADT is one of the best.

[LearnAll in reply to Hidden]

"Once cancer cells lose some of its androgen sensitivity, chemotherapy will become a valuable treatment."

Great statement. Fully Agree. Chemotherapy is an equal opportunity killer. Kills both .androgen sensitive as well as androgen independent cancer cells.

In the early part of treatment, almost all cancer cells are androgen sensitive and very vulnerable to attack by ADT.....when most of these cells get killed, the remaining surviving ones get desperate to find non androgen fuel for growth. This is precisely the point when we might need our big gun, Docetaxyl chemo.

I did not go for chemo first for the above mentioned reason. My PSA is down by 99.92 %

so the androgen sensitive population is pretty much dead. The tiny bit population left which has to learn to use non androgen fuel might take many years to grow to cause harm. Also, some of these will be tackled by immune system.

'

[Tall_Allen]

I think it is a good idea to give his body a break from the chemo. Xofigo or abiraterone is a good follow-up:

pcnrv.blogspot.com/2019/12/...

[Cheerr in reply to Tall_Allen]

Thank you. I guess one does need a break after 6 cycles. Hoping zytiga will take care of the rest for now.

[Shooter1]

I never got as low on readings as him. Went 9 cycles and added Xtandi after tests before # 5 as PSA was climbing. Ended up a complete invalid after chemo and Xtandi together. Had to cut to 1/2 dose xtandi after finishing the 9 cycles, Recovered enough to go back to work for 3 1/2 mo. and retired. Permanent neuropothy in feet and hand. Feeling came back in face, butt, arms and legs, but dead nerves in wrists down into hands and ankles down into feet. Was it worth it??? Pushed aPca into remission and I am way past Drs. first expiration date. Life is good just way different.

I had same 25% drop in PSA each cycle that you are getting until it leveled out after #7. I pushed too hard, so watch side-effects carefully. Best of luck to you.

[Cheerr in reply to Shooter1]

Nice to know that the Pca is into remission after all that neuropathy and side effects you had to endure. I just understood how the disease/treatment effects can be hard to deal with even when you are aware that your Pca is in remission.

I know neuropathy is not entirely treatable but so was Pca, you got through one, and I do hope you will find a way to ease your neuropathy too.

[tom67inMA]

Wow Cheerr, that's a very similar response to treatment as mine. Lupron really dropped my PSA, while docetaxel dropped my ALP each infusion and it would rebound a tiny bit just before the next infusion, then drop again.

I went onto zytiga after 6 cycles of chemo. The last two were much tougher, really glad I didn't have more.

Since your dad has such similar treatment and results, tell him he'll be able to run a half marathon in a few months

[Cheerr in reply to tom67inMA]

Thanks Tom. Yes, the treament plan and results are quite similar. Good to know you're doing well

I guess one does deserve a break post 6 cycles. I hope you get a long - term response with Zytiga.

[Patrick-Turner]

One has to consider chemo side effects. I had 5 shots finishing over 14 months ago and still have neuropathy in legs and feet. However, for me, chemo made Psa rise from 12 to 45+, so there was no point in me continuing with chemo and I switched to Lu177 which seems to have worked well so far with last Psa at 0.32, plus Xtandi . But no matter what we do, its likely that Psa will rise again later because all these treatments have a mean time of effectiveness.

Your dad's Psa is very low at 0.07, so Lu177 may not be effective because of low PsMa avidity. But ALP not low enough it indicates bone met reduction is not complete, and Xofigo might be good, ie, radium223.

Patrick Turner.

[Cheerr in reply to Patrick-Turner]

Thanks Patrick, so I am going to wait for cycle 5+6's results to see if ALP can drop much further. I'm hoping it will.

I'm glad you were amongst the people who received a good response with Lu177

[vandy69]

Over the past 2 1/2 years, I have had 16 infusions of Docetaxel/Carboplatin chemo (2 rounds of 6 cycles and most recent round of 4 cycles). Have rechallenged with Xtandi between rounds except for last round had chemo PLUS Xtandi.

With last round, PSA dropped from 48 to .2. Lymph nodes normal and liver lesions much smaller. NO bone involvement.

Bottom line—-limit first round of chemo to 6 cycles to allow recovery. Can always do more later.

Best Wishes. Never Give In.

Mark, Atlanta

[Cheerr in reply to vandy69]

Thanks for your response, Mark. Sometimes making treatment decisions causes a lot of anxiety. I just feel better knowing I asked any questions I have. I feel relieved now.

It's amazing how you were able to rechallenge Xtandi / Chemo many times. Wishing you good results.

[j-o-h-n]

Wishing you, your Dad and all others in your group "GOOD CHEERR".....

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 12/23/2019 6:23 PM EST