Looking for advice for friend

[Rottney]

A friend of mine has a much more aggressive form of PC than I do and I'm looking to get him some advice. His PSA continues to climb. Zytega worked for a month before PSA started rising again. Then was on chemo (docetaxyl) which only lasted two sessions before PSA began rising again. Tried Lynparza (he is BRCA2 positive) and that only worked briefly. Then had radiation as cancer spread to spine upper arm and several ribs. Next is a different kind of chemo.

Any thoughts or ideas from those of you who know a lot more than I do??

Roger B.

[Dachshundlove]

Hi Rottney

So sorry to hear about your friend. The chemo they will give him next is likely carboplatin. That might work really well because it targets a vulnerability of BRCA+ prostate cancer.

There are also parp inhibitors and again, for BRCA+ those can work very well.

My husband has BRCA and other repair defects and his cancer is tricky to treat too. It’s a bummer. There are options for BRCA. It’s been long associated with breast cancer so there has been a ton of research into that collection of defects.

You are a good friend.

[Tall_Allen]

Other than BRCA, any clues from biopsies of tumor tissue? (is his cancer PSMA+, PSA+, AR+, synaptophysin+, chromograninA+, neuronal-specific enolase+? Did they do a genomic analysis for MSH2, MSI-hi, dMMR, EZH2, HRD, CDK12, tumor mutational burden, PD-L1 ?)

[tallguy2]

Based on what you've shared with us chemo is next.

Best wishes for your friend, and for you!

[Hidden]

Some kind(s) of chemotherapy might be the next step for him.

There is second-line Taxane chemotherapy Jevtana (Cabazitaxel), often combined with Carboplatin or possibly the combination of Carboplatin + Etoposide for Neuroendocrine Differentiation. A biopsy can determine if he has NE PC.

[tango65]

He could consider treatment with Lu 177 PSMA and or Ac 225 PSMA in Germany or in Australia. There are a few clinical trials in the USA with Lu 177 PSMA:

clinicaltrials.gov/ct2/resu...

and one with Ac 225:

clinicaltrials.gov/ct2/resu...

[Hidden in reply to tango65]

These clinical trials on the East Coast, do they require that you reside or stay local the entire time. I live on the West Coast, would that automatically exclude me?

I have also wondered from time-to-time if one went to Germany, AU or SA for Lutetium treatments if the only way to do multiple treatments is flying back and forth as opposed to staying for a few weeks.

Just some rambling questions but none of our current Lutetium options for US citizens seems very easy short of flying to Germany and forking over the $dough and then repeating.

[tango65]

Unfortunately there are not good alternatives for Lu 177 PSMA treatment in the USA. If affordable you could stay in the east coast for the duration of the treatments. Treatments are usually done every 6 weeks,. Four treatments could take close to 6 months and it could be very expensive.

It is even more expensive to travel to Germany and pay for the treatments. People travel to Germany get the treatment come back to the USA and go back again for the next treatment. Australia is less expensive than Germany but the trip is longer and more expensive.

Germany requires the patient to stay 3 nights in the hospital. Patients are send home after the treatment in Australia. The stay in Australia could be shorter than the satay in Germany. It is a financial burden. Everybody knows that Lu 177 PSMA treatment helps more than 50% of the patients and it is becoming routine treatment in many countries. There are about 10 years of experience and tens of papers published. The FDA will not approve it until the results of Vision trial are known. It is not a cure but chemo, Xofigo, Provenge and the new anti androgens are not a cure either.

Best of luck!!

[Hidden in reply to tango65]

I really appreciate your explanation. Confirms what I knew but it helped to hear someone else say it. Saludos!