My fatigue after forth Docetaxel infusion

[ken12491]

Hello - had my 4th about 3 weeks ago - fatigue is getting worst and had chemo rashes after it too. Has anyone else experienced this too? Flu symptoms are still with me. Is this normal? thanks

my PSA is 0.34 and taking xtandi as well..

[Hidden]

Usually, in the third week the effects of the chemo infusion are minimal. If it's fatigue, I would suspect the Xtandi.

Although a recent trial showed PFS improvement doing both together, there was no improvement in overall survival. So I don't see a disadvantage of dropping Xtandi until you finish chemo.

onclive.com/web-exclusives/...

If it were me, I'd continue the chemo and stop the Xtandi for a while and see what happens.

[Tall_Allen in reply to Hidden]

I don't draw the same conclusion that combo treatment will be ineffective, at least, not yet. Here's why: the primary endpoint of the CHEIRON trial (Docetaxel+Xtandi vs Docetaxel alone) was progression free survival (PFS) at 6 months. The combo therapy was significantly better than docetaxel alone at that (89% vs 73%). Overall survival (OS) was a secondary endpoint in this Phase 2 trial because follow-up was not long enough (median, 20 months) and sample size was not high enough to see if the improvement in PFS might eventually translate to longer overall survival (the two month improvement is not statistically significant yet).

ascopubs.org/doi/abs/10.120...

urotoday.com/conference-hig...

There was also a small trial (Phase 1b) on the combination of Zytiga and docetaxel that showed some early PSA improvement.

europeanurology.com/article...

This interesting statistical analysis across cancer types suggests that an optimum combination therapy may have to inhibit 3-5 different pathways before a response-plateau occurs:

ncbi.nlm.nih.gov/pmc/articl...

[Hidden in reply to Tall_Allen]

In any case, dropping Xtandi for the rest of his time on chemo is unlikely to effect his PFS or OS. If it makes chemotherapy tolerable that's more important for him at this point, IMO.

[Tall_Allen in reply to Hidden]

I'm also not as certain as you that the fatigue is not caused by the 4th chemo infusion. I know several guys who had chemo without Xtandi and experienced fatigue that got worse as the # of infusions increased. Certainly the flu-like symptoms are common with chemo. But I do agree that both Xtandi and docetaxel cause fatigue and there may be a compounding of those effects when both are taken together. (I'm hopeful that darolutamide, which does not activate the GABAB receptor to the extent that enzalutamide does, will some day be part of a combo with fewer side effects).

[Hidden in reply to Tall_Allen]

I'm not certain what it is, nor did I imply that. I said I suspected Xtandi. It's easy to just stop taking Xtandi and see what happens which is what I am suggesting. Another option would be to reduce the dose of Xtandi.

Also hopeful that Darolutamide will have less fatigue and also hoping to get it down the road after chemotherapy if I get to that point.

[Sharksrule in reply to Hidden]

In the past I went from 4 pills of xtandi to 2 pills due to excessive fatigue and it seemed to maintain my psa while reducing fatigue. You could try this and if fatigue stays the same then chemo is the culprit.

[ken12491 in reply to Sharksrule]

thanks, will consider...best ken

[ken12491 in reply to Tall_Allen]

Thanks, Allen - taking xtandi 4 pills (160 mg) since Sept 10, 2019 and continued now during chemo that started in mid Oct 2019. I will certainly ask the MO but what is this actually buying me in PFS and OS based upon the trials you have seen?

[Tall_Allen in reply to ken12491]

Chemo adds about 3 months median survival and improved QOL. Xtandi adds about 2 months.

[ken12491 in reply to Tall_Allen]

Allen - 3 months on top of what base - what is median survival?

[Tall_Allen in reply to ken12491]

Each median is relative to the group of patients in that particular study. It depends on how far they were already progressed when they began treatment.

ascopubs.org/doi/10.1200/JC...

nejm.org/doi/full/10.1056/N...

[ken12491 in reply to ken12491]

Thanks, Allen.

[ken12491 in reply to Hidden]

Thanks, Gregg - will consider after talking with the MO --- taking 4 pills a day sine Sept 2019 (160 mg) and have continued since my chemo started in mid Oct 2019. Never suspected the Xtandi could be the cause.

[bellyhappy58]

I had completed 6th infusion in late Nov. Usually, the fatigue is felt 4th to 5th day after infusion. After that, it gets better...and be ready for the next infusion. During the 5th infusion, I had Lucrin and Zometa and the flu-like symptom persisted a little longer. I tried to take a short walk when I feel little 'flu-ish' and forgo my gym....It tends to make me feel better. Stay the course, your docetaxel treatment is working. God bless

[ken12491 in reply to bellyhappy58]

thank you belly hap - did you take xtandi too?

[bellyhappy58 in reply to ken12491]

Prior to the chemo treatment, I was on Zytiga (daily ) , Zometa & Lucrin ( once every three months) . Even though the zytiga was bringing the PSA down, i decided to go ahead with chemo as the Stampede study showed very good results for overall survival as well as hoping to zap any cancer cells in the body.

[bellyhappy58 in reply to ken12491]

I was and am only on Lucrin and zometa during and after the docetaxel treatment

[ken12491 in reply to bellyhappy58]

Congrats and thanks....

[Shooter1]

Taxatere and Xtandi together chewed me up and spit me out. 9 cycles with Xtandi added at 5th. 2 mo. after chemo done on Xtandi 160 mg I was complete invalid. Cut back, settled on 80 mg and PSA settled at 0.120/0.130 for last 18 mo.. With 80 mg got my life back.

[Hidden in reply to Shooter1]

Thanks, always interested to hear from people who've actually done some of these treatments. The practical realities don't always match with theoretical benefits. Glad you got your life back.

[ken12491 in reply to Shooter1]

shooter - glad to hear, appears to be similar to me... taking 4 pills, 160 mg and the chemo --- chewing me up too..80 mg might, will discuss with my mo...best ken

[Hawk56]

I had six cycles of taxotere from Jan-May 2018. The fatigue was manageable with the first three infusions, with the 4th it was extreme. I rested, did what I could in terms of activity, particularly exercise. With the the and 6th infusions the fatigue was better but still stronger than I experienced in the first three.

[ken12491 in reply to Hawk56]

hawk - were you taking xtandi too? thanks..

[Hawk56 in reply to ken12491]

Lupron

[tom67inMA]

For me each cycle of docetaxel got worse, and many times the second week of a cycle was better than the third week. If you're in the northern hemisphere it's also cold and flu season, and with a compromised immune system you can have some interesting reactions to a virus. Remember that cold symptoms are caused by the immune response, so it's possible to feel worse as your immune system comes back online which is what appears to have happened to me.

For what it's worth, I was only on Lupron at the time for ADT.

[ken12491 in reply to tom67inMA]

Thanks Tom - best to you...

[vandy69]

I have had 16 infusions of Docetaxel/Carboplatin chemo combo over the past 2 1/2 years (2 rounds of 6 cycles and most recent round of 4 cycles).

Have used Xtandi as a rechallenge after the first 2 rounds which worked for about 5-6 months.

Had chemo PLUS Xtandi during last round of 4 cycles.

Combination of chemo plus Xtandi drove PSA down from 48 to .2.

Mets in lymph nodes normal size and liver lesions reduced by 50%. Combo worked for me with a minimum of any added SEs, but everyone is different. Fatigue is cumulative with chemo, so it takes longer after each cycle to get back to your new normal.

Best Wishes. Never Give In.

Mark, Atlanta

[ken12491 in reply to vandy69]

wow! - 16 rounds - congrats and best to you...

[DarkEnergy]

During my 6 infusions of Taxotere, was on Lupron and Abiraterone Acetate/Prednisone 5mg, did get heavy fatigue, but I never forget what will be without these meds.

To have prostate cancer metastasis run unabated, the thought of these Pacman like cancer cells eating me out from the inside.

So, I'm not a happy camper with the meds, but choose life...