Questions to ask regarding an additional docetaxel infusion

[spouse21]

Sometimes life is like a Monty Python skit. "Do you want a punch in the nose or get hit on the head with a hammer?" That's kind of where my husband is this week. He will be talking over the phone with his MO at our local hospital, a satellite of Mass General. We both need to know what to ask.

Background:

--The hospital where he received his 7th docetaxel infusion two and a half weeks ago had a couple Covid-19 patients last week and is also scrambling for masks, protective gear, etc.

--After completing the planned 6 infusions, these were the findings from scans 3/4/2020, which were being compared to scans 10/2019:

bone scan: Multifocal activity consistent with metastatic disease is overall unchanged from October, 2019. No speciic evidence of progression of bone metastic disease.

CT abdomen/pelvis & CT Chest: No new lung nodules; stable right lower lobe nodule 4mm; Multiple small hypodense hepatic lesions are minimally smaller than October, 2019. Soft tissues grossly unremarkable. Redemonstration of numberous sclerotic changes throughout the thoracic spine, ribs, and sternum.

On 3/6/2020, MO offered three options: 1. no more chemo for three months then look at scans at that time to determine next treatment 2. half dose 3. Get a 7th full dose. My husband chose the 7th dose and had it that day. (We didn't know that was going to happen so didn't do the icing. Neuropathy is mild, but did increase, so he will tell MO that.)

Given this history, and now Covid19, which we do take seriously--we know some on this board disagree--what should we ask? Our daughter sent us an e-mail from a doctor she knows about the bell curve going way up throughout April, i.e. it's of course rising now, then possibly descending. With that in mind, should a question be whether to get #8 this Friday or wait until May in order to avoid the hospital? I recall that Gregg on this board suggested from his research that #8 was a good balance between disease control and quality of life/side effect issues.

What other questions should we ask the MO about #8? Honestly, I don't even know whether the stability/not worsening was "good news" or "okay news." My husband is 75 and started out this PCa trip six years ago. He still runs a few days a week; takes big walks; but does have that deep fatigue most of you have.

Thanks so much for plowing through this wall-o-text. I know most of us are on edge about the pandemic affecting treatment. If this were early on in the chemo my husband would go for it without a break; didn't hesitate about #7. But #8 would take place in a different landscape.

We wish you well with all your decisions and getting through these uncertain days. I hope I can help some of you when relevent questions come up.

[Hidden]

It sounds like the chemo is controlling the disease which is a positive. The general thought on chemotherapy after castrate resistance is that you continue as long as it's working and the side effects are tolerable.

The three things I would be considering are:

1. It sounds like the cancer is at least stable and not getting worse right now. 2. The side effects are starting to become an issue with the neuropathy. That tends to be cumulative so more cycles will likely make that worse. 3. The situation with COVID-19 is contnuing to get worse in the US for the time being.

If I was in this situation, I would be taking all of these factors into account and would probably wait and do imaging sometime down the road, possibly in May as your doctor suggested. I would want to know if Docetaxel is needed at that point and determine whether it is still effective or whether second-line Cabazitaxel is indicated. One advantage of Cabazitxel is it is less likely to cause neuropathy.

These are things you can discuss with the doctor. Wishing the best for you and you husband.

[spouse21 in reply to Hidden]

Thank you for responding, Gregg57. If I'm understanding, you would take #8 in three months after the next scan? I'll pass that on along to my husband in addition to asking about Cabzitaxel.

Wishing you the best, too. You're too young for this!

P.S. Forgot to mention in my question that scans are pretty much the way my husband's PCa is being tracked. He's more or less one of those low PSA guys despite mets.

[Hidden in reply to spouse21]

I would evaluate in 3 months after the next scans. Also would try to determine whether Docetaxel will still be effective or whether it's time to go on to Cabitaxel.

[Tall_Allen]

Stable disease is good news!

Considering the immuno-suppressive effect of chemo, and the hospital has many germs and recirculated air, (1) can you arrange for a visiting nurse to give the infusion at home? or (2) this may be a good time to start Provenge and layer in his chemo after the the second or third leukopheresis. But that will depend on how crowded the facility is and whether he has a good dendritic cell fraction to start with.

[Shooter1]

Cumulative SE at cycle #9 left me with permanent neuropathy in hands and feet. Think carefully about going beyond your # 8.

[spouse21]

Thank you, Tall Allen, Shooter, and Gregg. I will share your comments with my guy who will be consulting with our oncologist tomorrow or Wednes. I deeply appreciate the time all of you give so often. Shooter, I wish I could send you some kind of healing something or other, besides good wishes, to rid you of your neuropathy, but I don't have an advice in that department. Stay well, Men.

[Hidden]

You are my kind of person . Monty python has no peer .. a favorite and irreverent one is on YouTube where they are all on the gallows poles crucified singing” We’ve got to look at the brighter side of life”! It sounds like it’s working for him.. if it were I, I would get a shot of firmagon 3 month s and wait it out . Adt now might really help ? I’m not the expert . Congrats and getting thru it all . Keep laughing whenever possible.😂✌️

[spouse21]

Thanks for the support, Whimpy. I should've mentioned my husband has been on lifelong Lupron (aka "punch in the nose")with the chemo . We're big on the Pythons in our house. "Venezualan beaver cheese." Mmm. Better than Docetaxel.

[Hidden]

We're often stuck between a rock and hard place with this disease, having to figure out the lesser of evils, which thing is the higher risk, what will kill us first.

Many of us here are going through this process, living with side effects, giving up things in order to have life.

In the past I could take life for granted. It was always there. Now there are sacrifices to make and tradeoffs. The new life comes with side effects.

But, I have found some positive aspects of going through this process. For one thing, I don't take life for granted any more. It has become much more precious. Peace of mind and quality of life are now guarded with a new sense of urgency. When you have to fight for something and make sacrifices, you value it more, you appreciate it like you didn't before. That's been my experience.

[j-o-h-n]

I'd take a hit on the nose with a hammer....

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 03/24/2020 7:45 PM DST

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

I rather take a silly walk

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

youtube.com/watch?v=F3UGk9Q...(Not working as expected?)

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 03/24/2020 8:06 PM DST