Abiraterone instead of chemo in current covid-19 crisis?

[Proflac]

My husband was scheduled for chemo this week (PSA today is 2.2; 3 weeks ago was 7, down from 24 in Jan following decapetyl started in Feb. - Scans show no bone mets but mediastinal lymphadenopathy). (DX. July 2017 (T3a N1 M0). Previously had decapetyl and RT. TX ended 18 months ago.) The consultant recommended doce to start 3rd April. (ABI not available in UK for castrate senstive). However, this will not now go ahead due to the dangers of immunosuppression with covid-19 around, My question is Should we consider paying for private tx with Abi for the duration of the virus issue? Ie. we could pay for ABI for say 10 months. Could we clinically then switch to doce for the 6 cycles once the coast is clear from coronavirus? Would further ABI still be clinically OK if the chemo did not work? or would we have shot that bolt? Any help much appreciated.

[MateoBeach]

So he is responsive to the decapetyl ADT and the PSA is not rising. That would argue that the chemo and abiraterone could both be deferred at this juncture. Rather I would consider have evaluation for radiation treatment of the mediastinal node(s) by SBRT.

[Proflac in reply to MateoBeach]

Thanks. That's never been mentioned to us. I will ask about it on our phone consult, though even if clinically advisable I fear it wont happen in the crisis. They dont seem to do do much RT of nodes here in the UK - or at least that's my impression. I could be wrong.

[Hidden]

I agree that if he is still hormone sensitive and ADT is working, he deosn't need to do anything and could wait until castrate resistance occurs to add another treatment. Whether it's second-line ADT drug such as Abi or chemo would depend on what happens with the cancer between now and then.

The biggest benefit from early chemo in trials was for those with larger tumor burdens so I would not do chemo if I was in that situation because of the risks with the Coronavirus pandemic.

These are things to discuss with his doctor.

[Tall_Allen]

Yes, definitely start abi. It is available now as a lower cost generic. You can begin chemo later whilst continuing abi or take a break for 15 weeks while he has his 6 chemo infusions. Unfortunately, the mediastinal node is not amenable to radiation (did they tell you it is N1? It is usually classified as M1a.)