Has any tried low Dose Chemo (IPT)?

[Appraiser]

Just wondering how effective a treatment it would be versus regular chemo. It makes some sense that being less toxic you may be able to withstand more treatments if needed

[skateguy]

I did in Mid 2016. That was my only experience with any kind of Chemo. It's not approved by the FDA, therefore not covered under insurance and was approximately $2,200/session.

[Appraiser in reply to skateguy]

Was it an effective treatment for your situation? I notice a lot of alternative clinics are using it

[skateguy in reply to Appraiser]

When I did it, the Dr recommended that I get a blood test to determine the effective drug. The next appointment, he said forget the blood test, I know what to use. After nine chem. sessions, my PSA went up slightly and the Dr questioned himself about the choice of drugs. I was willing to take the blood test, and his statement caused be to stop. Also, some of the staff seemed more interested money than my health. I have lived with stage 4 PCA for over nine years and looking back, I think this may of helped me, and have been thinking about giving it another try. Sorry for the subjective response.

[Appraiser in reply to skateguy]

Thanks again.....I’m currently looking into clinics and will only chose one that offers it. It just seems like a pretty good solution.....I’m using all my bullets before I go conventional

[skateguy in reply to Appraiser]

I had it performed in Northern Virginia (Fairfax), just in case you are near by. I'm always looking for an alternative that is less lethal to my overall health but effective in killing cancer. Good luck.

[Shanti1]

Here is a 2012 study on IPT and Docetaxel vs IPT and an alternative chemo regimen in MCRPC: ncbi.nlm.nih.gov/pubmed/226.... There was no standard chemo group to serve as a control and the median survival was 11.7 months.

The authors state that the results are promising, but if you compare them to this study where docetaxel without IPT was given to MCRPC patients, you will see that the median over survival was 17.6 months: ncbi.nlm.nih.gov/pubmed/238....

You really can't get a fair comparison using two separate studies, but, even so, it doesn't make the IPT look very promising.

[Rkoma in reply to Shanti1]

Hi Shanti1,

I learned that looking on the abstract only is not enough to get the complete picture and make own opinion. Just some fact to the comparison you have done:

Median PSA in IPT/Taxotere group was 1511 and in TAX327 114!!! Median AP in IPT group was 1112!!! In IPT group 7of 8 patients were GS9. In Tax327 GS8-10 30%.

As you see these two trials are not easy to compare. Despite much worse baseline data for IPT the outcome was:

Mean remission time 10 months in IPT compared to 7,7 months in Tax327

PSA reduction >50% was 44% in IPT and 45% in Tax327 group.

QOL was much better ( not comparable with Tax327).

Hope these data shows what I meant with my 1st sentence in this reply.

Regards

Rkoma

[Shanti1 in reply to Rkoma]

I did look at the full text of both studies, which is why I wrote, "you really can't get a fair comparison using two separate studies.” However, in my opinion, despite the difficult comparison, if IPT chemo provided a substantial benefit in overall survival (OS), we would have seen a narrower gap in OS than 11.7 months vs 17.6 months. Of course we don’t know for sure, but other studies (in addition to the one I previously linked to) using docetaxel for MCRPC also had longer survival than the 11.7 months in the IPT trial: nejm.org/doi/full/10.1056/N..., pubmed.ncbi.nlm.nih.gov/157.... It is important to note that the objective of the study was to evaluate quality of life with the treatment rather than OS, and I agree that QOL was likely better. I am neither for nor against IPT, but it is an expensive treatment that is not (as far as I know) covered by insurance. People often travel to other countries to have it done. I would love to see more data, but for those trying to make a decision in the absence of data, we have to rely on what is available. Admittedly others may draw a different conclusion, but mine was that it doesn’t look promising as far as an advantage to overall survival.

Regarding the data of the participants in the study, I am not sure where you are pulling some of the numbers you put below. I think you may be confusing the first study that I linked to as a comparison between IPT chemo and regular chemo? It is actually a comparison between two IPT chemo groups receiving differing chemo regimen. This is why I posted the second study, to represent docetaxel alone. Please note that the median survival for the IPT/Docetaxel and IPT/Alternative chemo groups was 11.7, the study did not provide overall survival for each group independently, this is for both groups so we have to use the median combined PSA of 950 (not 1511). In the IPT/Docetaxel group there were 3 GS9, same for the IPT/Alternative chemo group, the other 5 in each group had a GS less than 9 (see Table 1), where are you finding that 7/9 were gleason 9? In the first study linked to, both groups had IPT, just with a different chemo regimen, so the mean remission was 10months for IPT/Docetaxel and 7.6 for the IPT/alternative Chemo group. I did not reference the TAX327 study in my original post, but I did pull it up to see what you were referring to, I don’t see anywhere in that study where a PSA of 114 is cited. If you do have data that show that IPT has an advantage in OS over standard chemo for PC, I would love to see it. My post wasn’t to conclusively say there is not benefit, it is just my opinion based on the limited data.

[Shanti1 in reply to Rkoma]

I apologize, I do see the 114 PSA in the TAX327 in one of the tables. I am assuming you brought the TAX327 study up because it is one of the references in the IPT trial, but it isn't the reference I posted for comparison. The study I posted for comparison (ncbi.nlm.nih.gov/pubmed/238... is also not a fair comparison, I wish we had one!

[Rkoma in reply to Shanti1]

Thanks for your answers. I fully agree with what you said, especially with „ I would love to see more data, but for those trying to make a decision in the absence of data, we have to rely on what is available.

Many MOs offer IPT but no any data about efficiency. Forsythe created a ppt with high level statements which looks promising but without a „trial like“ report it‘s hard to assess it.

GS9 data in my answer was a typo, sorry.

Regards

Rkoma