What determines whether the number of Docetaxel chemo infusions is 6 or 10?

[spouse21]

Curious about how a determination was made on the number of chemo treatments you received. At what point during your chemo treatment did you have scans? For those who had 10 treatments, how and when was this decided?

[Tall_Allen]

6 is standard, but if you are having a great response and side effects are mild, you can go for more. Many guys want a break, and alternating with something else is reasonable. As long as you are not chemo-resistant you can go for another cycle later.

[Bjry in reply to Tall_Allen]

Are there any guidelines on how long you should wait to go for another cycle and is 6 treatments still the standard?

[Tall_Allen in reply to Bjry]

Yes, 6 treatments is still standard.

[Hidden]

8 or more cycles gives the best median OS, but no benefit has been proven over 10. Practically speaking, other factors may ultimately determine how many cycles such as the grade of various side effects. Here's a link that gives more detail:

jwatch.org/na42213/2016/09/...

[spouse21]

Duly noted Gregg and Tall Allen. I realized too late that I was the second person to ask this question recently. My husband, Doug, and I appreciate so much the time you guys spend sharing your solid research. Thank you so much. Happy New Year.

[Hidden]

It's best to consult the prescribing sheet for those kinds of treatment limitations since there are other blood numbers also taken into account for prescribing chemotherapy. There are hard limits at certain levels and also numbers where a reduced dose is acceptable.

products.sanofi.us/Docetaxe...

[BigM62]

I had ten cycles. Originally my MO said we would do as many as my body could take. I was 55 and diagnosed with very wide spread spinal Mets. There were to many to count with at least one major one in danger of cord compression. I’m not sure if my age and excellent fitness (I was already a vegan ultra marathon runner) played into that comment, but at the time I took it as related to the large tumor burden. My symptoms had developed rapidly and I went from undiagnosed and “fit” to severe back pain and needing a catheter in a matter of weeks.

Chemo was not a walk in the park, but I took it very well with the unfortunate exception of neutropenia which was a big issue from round 1. By round 10 I was getting ER visits for fevers and my weekly blood numbers just weren’t rebounding regardless of how many shots they gave me. So we stopped.

It was 4 rounds before I could finally pee again and the catheter bag could come out. My PSA hit undetectable around cycle 6. But I’m very happy we kept going. I didn’t have 2nd scans until AFTER the 10 cycles, but it showed all of the Mets resolved and no visible cancer (we all know it’s still there of course). And my marrow tests came out clean.

Last infusion was March 2018. I’ve been on Lupron alone since. Still undetectable PSA for now although I still have pee issues and back pain.

[spouse21]

Thank you for sharing your experience, BigM62. It's quite an account. After all that, it's great that chemo gave you such a good response. May it continue!

[vandy69]

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

Between each chemo round, we rechallenged with Xtandi.

Last round was chemo PLUS Xtandi. Had only 4 cycles because response was outstanding—PSA driven down from 48 to .2.

Basically if your cancer is responding to chemo, you can have more rounds, but after 6 cycles your body needs a break to recover. Eventually the SEs of chemo will outweigh the benefits, so you want to delay that crossover point for as long as possible.

Best Wishes. Never Give In.

Mark, Atlanta

[paulcross4]

I'll hit 14 tomorrow. Done over the last year with a month break. PSA was reduced by it, pain taken to zero, side effects manageable, toleration good by the numbers. I think I'm coming to the end now, but it's been just fine for me for the last 10 months.