Chemo or abi in covid times?

[Proflac]

My husband is due to start docetaxel for hormone sensitive PC which has spread to chest lymph nodes only. Due to start in 2 weeks. But with this virus this will be dangerous. Should we go for Abi instead? We would have to pay but can do so. Any views welcome. Thanks

[gcman]

There’s a trial that shows similar outcomes for either choice, so I would go abi. Better tolerated overall.

[Proflac in reply to gcman]

Thanks. I guess we dont know how long we would have to take Abi for. Even de Bono says he would probably still go doce then abi, but that's not in the current climate.

[tom67inMA]

I can relate. I'm currently in chemotherapy (Carboplatin + Etopiside) for neuroendocrine PCa and Covid-19 is especially worrisome. Even if you don't catch the virus, there's risk that a stressed healthcare system will run out of things necessary to continue the chemotherapy. Something as simple as a shortage of saline IV bags could cause treatment delays. I don't have any other good options, you do.

What I will say about docetaxel is that it only compromised my immune system for about a week or two, and then it would bounce back to above normal levels in the third week. It may still be a better choice if your husband has widespread disease. I had docetaxel followed by abiraterone and it took my PSA all the way to <0.01. I'm still on the abiraterone and PSA is still <0.01, so the non-neuroendocrine cancer still seems to be well controlled.

[Proflac in reply to tom67inMA]

Sorry to hear you are back in treatment in such difficult times. I think doce then abi would be our preferred route but I think with the risks of chemo at the moment and the likely shortage of ITU beds in the uk we might go the abi route. Anyone know how long people take this for or is that an impossible question?

[tom67inMA in reply to Proflac]

Generally it's taken until it stops working which could be years. Some members here have been on it for 7 or 8 years and still going. We don't know how long it could last because it hasn't been available for a decade yet.

Some men do eventually reach no evidence of disease and try stopping. For a lucky few the cancer stays away after T comes back. More frequently though, the cancer does come back after stopping treatment.

[Proflac in reply to tom67inMA]

Thanks for that. We couldn't self fund for that long without selling the house. His disease at the moment is not in bones or other organs, 'just' mediastinal, subcarinal and hilar lymphodenopathy.

[Hidden in reply to tom67inMA]

Why are you taking Carboplatin + Etopiside with a psa of 0.01?

[tom67inMA in reply to Hidden]

Neuroendocrine. It got into my bladder and tried to choke my kidney. Also metastasized to liver. All with undetectable PSA.

[Hidden in reply to tom67inMA]

Sorry.

[tom67inMA in reply to Hidden]

No need to be sorry, chemo is working very well at the moment

[timotur in reply to tom67inMA]

Tom, was your ALP going up while NE was taking off? My ALP is trending up with PSA <0.01.

[tom67inMA in reply to timotur]

Hard to say. My ALP bottomed out in the low 30s, which was lower than it had ever been in blood tests years before any cancer. By NE diagnosis it was in the 40s, which was more normal for me. Since treatment began it went up to around 60, last test in the 50s. So it's been bouncing around, but nowhere near the multiples of hundreds I had in 2018.

[timotur in reply to tom67inMA]

Ok, thanks. Mine was mid-70s before dx, then fell into the 40s during Brachy/IMRT, six months later it's risen to around 100 with PSA <0,01. Hopefully it's just bone activity from being on Lupron for a year, i.e. apposition from bone loss caused by ADT. It doesn't sound like NEPC causes a rise in ALP like metastatic PC does.

[tom67inMA in reply to timotur]

In theory it should cause a rise if it attacks bones, as the ALP is produced by osteoblasts if I understand correctly. Even if it's a lytic lesson there should be some ALP as the bone tries in vain to repair itself, albeit not as much as a plastic lesion.

And of course, cancer has a nasty habit of ignoring what it should be doing and doing whatever it damn well pleases.

[Proflac in reply to tom67inMA]

Thanks for your reply. Good that you got the Prostate cancer zapped. Hope the same effect for the neuroendocrine. We have been offered shots to help white blood cells, so that might help bring up immune system.

[tom67inMA in reply to Proflac]

My MO has been reluctant to use such measures, and in fairness my white cells have been recovering on their own. The downside to the immune boosting shots is that they stimulate the stem cells in your bone marrow making them more susceptible to chemo, which can have longer term consequences. Of course, you have to survive today before you can worry about the long term.

[Tall_Allen]

Ask for Neulasta.

[Defense]

Quality of life is generally better with Abi than with Docetaxel. Something to keep in mind.

[Buddy1950]

My husband is on his way home from Mayo. He finished 6 sessions of Docetaxel and has been on firmagon. Lung nodes only, gleason 8, 2.1 psa a year after surgery (.44 3 months after surgery).... Dr. Kwon did scans frequently until it showed up in his lungs. Yesterday scans are clear, blood work is great (<.03) and other blood work fine. He received neulasta with the docetaxel and it was not terrible with the help of claritin and prilosec and then only for the first week. He got both docetaxel and neulasta locally and only goes to Mayo for scans now and in 3 months. Dr. Kwon did not want to use abiraterone first for various reasons, it was listed if the first two treatment options failed. He questioned the wisdom of salvage radiation with the low success rate quoted by the Mayo radiologist. All in all .. we are very grateful and know that lots of this is just good luck and may be wrong for someone else. Chemo was not terrible... and with neulasta his wbc etc was great. Not sure of interest... but his alkaline phosphatase went up in the last two weeks, not out of normal range, but they said neulasta can do that. Had to go to the ER one night as the vein looked very red and moving up (guess a technique issue) ... but not mentioning neulasta caused some concern as the blood work looks very odd. Susan

[Proflac in reply to Buddy1950]

Thanks. We have been offered neulasta ir similar if dice hoes ahead. Really pleased your hubby is doing well. But now were are in coronavirus times and this makes it so much more difficult to choose. In the UK we are expecting a death rate of c. 10 for older people with underlying conditions and that's without the added immunosuppression. I don't think we have really taken in the enormity of the impact of this virus.

[Proflac in reply to Buddy1950]

Thanks, its good to know that chemo can go well. And we were resigned to going that route. But this is before coronavirus adds in its dastardly risk into the equation.

[j-o-h-n]

Hello Proflac.... would you be kind enough to give us more info regarding your Husband: Age, Location, Scores PSA/Gleason, Treatments to date, Treatment center(s), Doctor's name(s). All info is voluntary but it helps us help you and helps us too. Thank you!!!

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 03/18/2020 6:55 PM DST

[Proflac in reply to j-o-h-n]

Hi. Husband is 73 in otherwise fair health. Diagnosed 3.5 years ago, Gleason 4+4, PSA 15, N1 M0. ADT for 18 months plus RT. PSA down to 0.04 lowest. He did have an MI with one stent in 18 months ago - which I reckon could be ADT related as he had NO risk factors for CVD. Anyhow, all well until January 2020 on no tx then PSA to 16, then 24 within less than 2 months. This was scary. Regular bone scan shows no obvious lesions, CT shows pathological nodes in chest - no other vascular involvement, though it was just a regular CT not PET.etc. So now we are M1. So back on the ADT 6 weeks ago - PSA now down to 7 after a month and he has done another test today to see how its gone since. So, this is our scenario. He has been scheduled for chemo supposed to start 3rd April. This seems risky in the light of covid-19. But, is it more risky to wait for a few months (could be 5 months maybe even more?). Abi not available for him here in the UK, unless we self finance the whole tx package - drugs, tests, etc. Our onco suggested chemo as its over and done with, and then abi is there later if and when needed. whereas the other way round, he might be too poorly for chemo after abi stops working. We are wondering to delay the chemo till after the virus peak - will this be too risky? We thought maybe to see is the ADT is doing its job? If the PSA is still going down does that mean its safe to wait? We can isolate quite well where we live, but would have to go to hospital for chemo - which seems a biggish risk, though I understand that chemo units are pretty good at infection control! Any views?

[tom67inMA in reply to Proflac]

After reading this extra info, I think docetaxel + maybe neulasta or similar may be a great option for your husband despite my earlier reply above. I'm more than 20 years younger, which generally means my immune system will recover faster on its own.

[j-o-h-n in reply to Proflac]

Thank you for your detailed reply. You may wish to cut and paste this on your home page under your userID for future reference. Since you asked "any views" at the end of your reply I think it would be a good idea to cut and paste this in a new post and hopefully get some responses.

Good Luck, Good Health and Good Humor.

j-o-h-n Friday 03/20/2020 6:26 PM DST