Abiraterone Failure

[Chivato646]

I began Abiraterone on Jan 11,2020...my last three PSA readings are .76 12/11/20), 2.1 (2/25/20), 3.9 (3/27/20)...so I have failed abiraterone...(have ruled out BRCA2+ mutation...also I believe we have ruled out AR-V7 expression)..my alkaline phosphate remains good at 45...next choice seems to be enzalutamide (I responded well to Casodex and hope to not be cross-sensitive vis-à-vis abiraterone) and Xofigo (I already receive Zometa to mitigate bone issues) or Cabazitaxel...I see my MO tomorrow...any fellow warriors faced with a similar scenario?...was there an interim period between abiraterone application and the start of enzalutamide?...this train has suddenly picked-up speed and it will be derailed...any word on experience with Cabazitaxel?...thanks for any wisdom afforded me...hang tough warriors...D

[Tall_Allen]

I think cabazitaxel is best for next:

pcnrv.blogspot.com/2019/12/...

After 15 weeks you can try the xtandi+Xofigo+Zometa+Celebrex

I think this sequence provides the most therapies in the least amount of time.

[Chivato646 in reply to Tall_Allen]

seems like the "play" to me as well TA...failing abiraterone so quickly was surprising to say the least...really thought I was getting on top of this beast...I have felt good throughout (no side effects) Lupron, Docetaxel, Zometa...greatly appreciate you taking the time to comment...stay strong...D

[middlejoel in reply to Chivato646]

Hi, where you taking the full dosage of 1,000 mg?

[Chivato646 in reply to middlejoel]

yes...every morning...and I often ate within 60 minutes of taking the abiraterone...went a full 60 days with no positive impact on my PSA...

[Chivato646]

Thanks for the reply Nalakrats...always greatly appreciate your input...I will grill my MO and ensure that all of AR-V7 "partners" were tested for...I swear I want to assay the abiraterone to ensure that the pharmacy didn't pull them from a Pez dispenser...B'ezrat Hashem...D

[TeleGuy]

If you haven't already, try switching from prednisone to dexamethasone, that may buy you some time to make up your mind on what's next. Search for the SWITCH trial. Just the steroid switch cut my PSA in half the first month.

[ctflatlander in reply to TeleGuy]

What was your psa before the switch and how long have you been on dexa? Thankyou

[TeleGuy in reply to ctflatlander]

I was on goserelin+abiraterone+prednisone and my PSA started shooting up and reached 3.10. I switched from 5.0 mg prednisone to 0.5 mg dexamethasone and in just over 6 weeks my PSA went down by 80 percent to 0.63. At that point I stopped the abiraterone because I began 177Lu-PSMA treatment, however for me it served the purpose of giving me time to decide what would be next. The docs in Munich cited a small study that showed a negative impact of abiraterone with the lutetium treatment and preferred me to be off it. The benefits of the steroid switch can be short-lived or long-lived, and it doesn't work with everyone. Here's a link to one of the articles about switch:

nature.com/articles/s41416-...