NEPC Treatment Update

[Bird8]

Hello all,

Mike was dx with NEPC this past summer. He just completed 6 cycles of carboplatin+etoposide+tecentriq at the beginning of January. Scans completed at the end of January revealed that things were stable. Although the lymph nodes didn't shrink much, they didn’t grow. We were happy with this report. He completed 2 cycles of just immunotherapy (tecentriq), when it happened. The cancer grew. New lesion on the liver. New lymph node completely obstructing the right kidney. All previous stable lymph nodes increased in size. We landed in the emergency room on Sunday due to excessive swelling/fluid build up in the groin, stomach and legs. He was admitted and a nephrostomy tube was placed. Now we are in a position of trying to get the beast under control. Mike will start radiation next week. There is discussion of chemo again (Docetaxel). This will be his 3rd round of chemo. He had Docetaxel back in 2017 when he was originally dx. They want to hit it hard and quick due to how quickly it is spreading. The cancer is taking its toll on him, mentally and physically. Mike is only 47. We have 2 young boys (8 & 11). This is a horrifying position to be in. We have an appointment set up with Dr. Beltran on April 1st. He will be in the middle of treatment and I fear he won’t be able to make the trip and not sure I want to run the risk of exposing him to all of the sickness going around.

What I’m wondering is this...

There was talk of starting a parp inhibitor bc Mike carries the BRCA2 gene but they are worried it will take too long to go into effect. Is Docetaxel a reasonable choice? NEPC is usually hit with platinum chemo. How effective are the taxane chemos against NEPC?

Thank you for taking the time to read this,

Nikki

[Tall_Allen]

They give docetaxel because it is often a "mixed type" of neuroendocrine and acinar adenocarcinoma prostate cancers. If it is all neuroendocrine, there is no point to adding docetaxel.

[Bird8 in reply to Tall_Allen]

It’s mixed. Platinum chemo was minimally effective. It’s all a leap of faith. He responded well to docetaxel when it was just adenocarcinoma back in 2017. I’ve reread your earlier post about treatment for NEPC. I will be sure to share this information with his oncologist later today. We are up against the clock and time is not on our side. TA, thank you for always replying back to my posts. Your insight is much appreciated.

Nikki

[V10fanatic in reply to Tall_Allen]

If it's usually mixed, why not go with platinum based chemo first and take out the most deadly variants?

[Tall_Allen in reply to V10fanatic]

They can make a cocktail.

[V10fanatic in reply to Tall_Allen]

How does that change the side effect profiles?

[Tall_Allen in reply to V10fanatic]

Ask your MO.

[V10fanatic in reply to Tall_Allen]

I found this from a clinical trial ncbi.nlm.nih.gov/pmc/articl...

there is a significant increase in side effects from what I see.

Adverse events occurring in 10% or more of patients are listed in table 2. The most common grade 3–5 adverse events were fatigue (7 [9%] of 79 in the cabazitaxel group, 16 [20%] of 81 in the combination group), anaemia (3 [4%] in the cabazitaxel group, 19 [23%] in the combination group), neutropenia (3 [4%] in the cabazitaxel group, 13 [16%] in the combination group), and thrombocytopenia (1 [1%] in the cabazitaxel group, 11 [14%] in the combination group)

[Tall_Allen in reply to V10fanatic]

So? One makes the decision based on the benefit to risk ratio. This is something to discuss with your MO.

[Tall_Allen in reply to Tall_Allen]

This may be useful to you in informing your decision:

pubmed.ncbi.nlm.nih.gov/315...

[tom67inMA]

So sorry to hear! Obstructed kidneys are no fun, I've got a stent in one of mine.

Is he still on the tecentriq? There's a small chance it will be synergistic with the radiation. Look up "abscopal effect".

Is there a reason the can't use both a PARP inhibitor and chemo at the same time? I'm no expert on any of this, just hoping they can find one thing that gives him an exceptional response.

[Bird8 in reply to tom67inMA]

Good point and I’m not sure. I have not spoke with onc yet about this new plan so I am working with limited information. I will be sure to update this post after I’ve had a chance to discuss things with her. Hope you are doing well! 💪🏼

[Bird8]

Thank you Nala! This is great information.

[Hidden]

Great Photo! Wish you both many happy years together .

[Rooked]

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

This may work. Ask your medical oncologist. Good luck.

[Hirsch in reply to Rooked]

Agree. Certainly worth a try

[Bird8 in reply to Rooked]

Thank you Rooked! This is great information.

[JLS1 in reply to Rooked]

Thank you!!! I just wrote a new post about this, thanking you, so that more people can see this. I'm VERY excited to look into this more! Sounds like it may be the answer when a Hail Mary is needed??

[Rooked in reply to JLS1]

Your welcome. Since prostate cancer is hormone dependent, there are probably other hormones that need to be suppressed to stunt growth of the tumor(s). Also inhibiting copper which can spread the tumor and adding zinc can probably help shrink the tumor‘s. I just found this article last week on Google Scholar and I think this is very intriguing.